DENTEDIT Payment integrity
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Solutions

Five people have to say yes. Each of them asks a different question.

An enterprise payment integrity decision is never one buyer's. Here is what DentEdit answers for each seat at the table — and what we will show rather than assert.

PAYMENT INTEGRITY & CLAIMS OPS

"Will it hold up when the practice appeals?"

Pend rates you can defend, an overturn rate you can explain, and edits whose precision is measured from your own appeal outcomes rather than asserted in a vendor deck.

Exposure-ranked queue

With SLA, so the highest-dollar ambiguity is worked first rather than the oldest.

Shadow before active

See exactly what a new edit would have done to last quarter before it touches a dollar.

Overrides that mean something

Write-once, reason-bearing, role-gated — and reported back as a pattern per rule.

Paperwork never denies

Attachment gaps request information. That single rule removes a whole class of overturns.

CIO & CHIEF ARCHITECT

"What does it cost me to run, and what does it assume?"

One evaluation path with no session state, six intake channels on one flow, and every figure published with the volume and conditions it was measured on.

>1K claims/sec, reference hardware

Sustained with p95 under 100 ms and no errors on a single developer-class machine. Our measurements ship with the machine behind them, and we re-run the benchmark on your infrastructure.

Our SaaS today, your VPC planned

Same engine, same controls, same evidence — and administration is already separate from claims data.

Runs with no model provider

Assistive AI is opt-in and off the critical path. The shipped default has no provider connected at all.

No silent degradation

A misconfigured deployment refuses to start rather than quietly running on the wrong data.

COMPLIANCE & PRIVACY

"Who read this record, and what left the building?"

An append-only access and export trail captured at the read, eight self-serve compliance answers, and an AI boundary that names what it removed.

No engineering ticket

Your auditor follows the links the platform itself publishes, so a compliance review does not become an engineering project.

Coverage and gaps published

The trail reports its own completeness instead of leaving you to assume it.

De-identified by default

Including identifiers hidden inside engine-authored prose, with the removal disclosed.

Refusals disclose nobody

A denied read never names the member it refused to show.

COO & CFO

"Which of these numbers can I put in a board pack?"

The ones that reconcile. Withheld dollars decompose into contractual, alternate-benefit and edit-driven savings with no overlap, summing exactly to what pricing wrote off.

Cost sharing is not a saving

Routine deductible, coinsurance and coordination sit under "not savings", by construction.

Estimates never inflate a figure

Predeterminations are held out of every monetary report, and the count held out is published.

Unmeasured is not zero

A rate with no denominator reports as absent rather than as a flattering 0%.

Cost scales per patient, not per book

Not per plan, and not with the size of your claim history.

CLEARINGHOUSE & TPA PARTNERS

"Can I offer this to my payers without owning their data?"

The plan boundary and the separate content environment were built for exactly that shape: you author and distribute content, each payer’s member data stays inside its own boundary, and one payer’s benefits can never price another payer’s claim.

Licensed content packs

Distributed through the Content Update Manager; a pack rule arrives as a draft, never as active policy.

A pack cannot activate itself

Your payer's own four-eyes gate decides, which is what makes the offer sellable.

Credential-bound channels

One credential, one tenant. A file name or sender id can never redirect a claim.

Administration holds no member data

The administration environment is refused every data operation, and that separation is verified independently.

Lines of business

Dental is not one policy environment.

Program rules are chosen by the member's enrolment, never by a value on the submitted claim. That distinction is the difference between a state audit finding and a clean one.

Commercial

Plan design, waiting periods, annual and orthodontic lifetime maximums, alternate benefits, and coordination with a second carrier per line.

Medicaid

State program packs with published rate tables, documentation policy and diagnosis requirements — and a claim refused rather than priced when the schedule supplied is not the one the state's pack names.

CHIP

Age-limited benefits assessed against the patient's own date of birth — a named dependent never inherits the subscriber's age, in pricing or in an authored rule.

Medicare Advantage dental

Supplemental benefit designs, network-aware write-offs, and the same evidence trail your plan's own oversight will ask for.

Bring the whole table. One call answers all five questions.

Claims lead, architect, privacy officer, finance. We would rather be interrogated once than pitch four times.

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