The Situation
A surgical practice does not have an eligibility problem. It has a completeness problem. Confirming a patient is active takes a minute; establishing whether a specific implant case will actually be covered takes far longer — missing tooth clauses, waiting periods on major services, frequency limits on grafting and extractions, downgrade provisions, annual maximums already consumed elsewhere, and whether any part of the case has to go to medical first.
Before Iverifai, that work sat with two members of the front office, who between them spent at least 20 hours a week on the phone with payers. Cases were routinely presented on partial information, and the treatment coordinator was reconciling estimates against reality after the fact rather than before.
What Changed
Iverifai reads the schedule directly from Dentrix and works a 72-hour lead. Every patient is verified using the practice’s own breakdown form — the same form the coordinator was already using, unchanged — and the completed breakdown is written back into the chart before the appointment.
The form for this practice carries fields most general offices never need: missing tooth clause status, implant and graft coverage with any exclusions, waiting periods with remaining months, downgrade language on crowns and bridges, remaining annual maximum as of the appointment date, and a flag where the case may have to be submitted to medical first. Anything the payer will not release electronically is escalated to a specialist who calls.
150 payer calls against 350 verifications is 43%. Nearly half of this practice’s verifications cannot be finished electronically — and this is a PPO practice, not a Medicaid one. The gap is not a payer-mix problem. It is what electronic eligibility does not return.
Results
