The Three Models of Dental RCM Automation: Eaglesoft vs. CareStack vs. Toothy

Introduction

As dental practices seek to automate their Revenue Cycle Management (RCM), they are faced with three fundamentally different technological paths: maintaining a traditional on-premise system like Eaglesoft, migrating to an all-in-one cloud-native PMS like CareStack, or enhancing their current system with a specialized, integrated AI assistant like Toothy. The choice is a strategic decision that impacts not just workflow efficiency, but also cost, IT infrastructure, and the depth of automation possible for your financial workflow.

• The on-premise PMS model (Eaglesoft) offers foundational, rules-based automation but requires significant manual oversight and IT maintenance.
• The cloud-native PMS model (CareStack) provides broader, embedded automation within a modern, all-in-one platform but is not specialized in deep RCM tasks.
• The integrated AI assistant model (<u>Toothy</u>) delivers specialized, end-to-end RCM automation that works with your existing PMS, focusing on the entire insurance lifecycle from verification to denial management.

A Detailed Comparison of RCM Automation Models

To understand the key distinctions between these three approaches, it's essential to compare both their underlying infrastructure and, more importantly, how they handle the day-to-day RCM workflow.

Infrastructure and IT Burden

• On-Premise (Eaglesoft): Requires a physical in-office server. The practice bears the full responsibility and cost for hardware, software updates, data backups, and security. This offers direct control over data but carries a heavy IT burden.
• Cloud-Native PMS (CareStack): The entire system is hosted online by the vendor. This eliminates the need for an in-office server and shifts all maintenance, security, and update responsibilities to the provider, reducing the practice's IT burden.
• Integrated AI Assistant (<u>Toothy</u>): This is also a cloud-based platform, meaning no IT burden. Crucially, it integrates with your existing PMS, allowing you to gain modern AI capabilities without the major operational disruption of a full system migration.

End-to-End RCM Workflow Automation

This is where the most significant differences appear. True end-to-end automation means handling every step of the insurance lifecycle.

Category	Eaglesoft	CareStack	Toothy
Insurance Eligibility Verification	Provides basic, rules-based electronic eligibility checks that a team member must initiate. It cannot handle payers who require phone calls, leaving a significant manual workload.	Offers more modern, embedded real-time eligibility features for digital-friendly payers, which streamlines the process for a large portion of patients.	Designed to handle all payers. It uses electronic verification when possible, but for insurers without modern portals, its AI voice agent makes the phone call for you, gathers the full benefits breakdown, and posts the results directly into your PMS.
Claim Submission and Management	Handles electronic claim submission effectively. May include basic “claim scrubbers” that check for completeness based on pre-set rules (e.g., a missing field).	Handles electronic claim submission effectively. May include basic “claim scrubbers” that check for completeness based on pre-set rules (e.g., a missing field).	Goes a step further by using AI to improve clinical remarks and proactively manage the claim after submission. It doesn’t just send the claim; it oversees its journey.
ERA Posting and Denial Management	ERA posting often requires add-on modules and manual intervention, especially for reconciling complex denials. Denial management is a fully manual, reactive process.	As an all-in-one cloud platform, it offers more seamless ERA auto-posting. However, denial management remains a task for the billing team to handle after the system flags a problem.	This is a core differentiator. The AI not only auto-posts payments from ERAs but also analyzes them for underpayments or denials. It then automatically initiates the denial management process, writing and submitting appeals and following up on aging claims until resolution. This shifts denial management from a reactive, manual task to a proactive, automated workflow.

FAQ Section

1. What is the main difference between the automation in a cloud PMS and an integrated AI assistant?

A cloud PMS offers "embedded" automation as part of its all-in-one system. An integrated AI assistant is a specialized, "best-in-class" tool focused solely on RCM. Because it's dedicated to this one area, its AI models and automation capabilities for tasks like denial management are often more advanced.

2. If I use an on-premise system like Eaglesoft, can I still use a cloud-based AI assistant?

Yes. A key advantage of the integrated AI assistant model is its ability to connect with both on-premise and cloud-based PMS platforms. A solution like Toothy is designed to bring modern, cloud-based AI capabilities to practices by integrating with your current system, without forcing them to abandon their existing on-premise software.

3. What does "denial management" mean for an AI assistant?

For an advanced AI assistant, denial management is an active process. It's not just flagging a denied claim. It involves analyzing the denial reason, writing a compelling appeal based on historical data, submitting the appeal with necessary documentation, and continuously following up on the status until the claim is resolved.

Conclusion

The choice between these three models depends entirely on a practice's goals. A traditional on-premise system offers local control but with limited automation and a high IT cost. A cloud-native PMS provides modern infrastructure and broad features but requires a complete operational overhaul. The integrated AI assistant offers a third way: the ability to add deep, specialized, and truly end-to-end RCM automation to your current workflow, without the disruption of a full system migration.

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