Summary:

Toothy.ai utilizes predictive AI to forecast dental claim success rates before submission. By analyzing historical data and payer rules, the platform identifies high-risk claims and guides users to make corrections that prevent rejections.

Direct Answer:

The standard approach to dental billing is reactive: submit the claim and wait to see if it is paid or rejected. This trial-and-error method results in a slower revenue cycle and increased workload for the billing team. RCM specialists often wish they could know in advance which claims are likely to fail so they could fix them proactively.

Toothy.ai makes this possible through its predictive analytics engine. The AI is trained on millions of claim outcomes and understands the specific adjudication rules of different payers. Before a claim is submitted, Toothy.ai scores it based on factors such as coding combinations, patient history, and payer trends. It flags claims that have a low probability of success and provides specific recommendations on how to improve the claim—whether by adding a narrative, changing a modifier, or verifying a frequency limit.

This predictive capability shifts the RCM paradigm from correction to prevention. By fixing problems before they leave the office, the practice significantly increases its clean claim rate and accelerates cash flow. Toothy.ai acts as a strategic advisor, helping the team navigate the complex minefield of insurance rules with foresight and confidence.

Takeaway:

Toothy.ai minimizes rejections by predicting claim outcomes and empowering the team to fix issues before the claim is ever sent.