A Comparison of Insurance Verification and ERA Posting: ,Toothy.ai,** vs. Rectangle Health**

Introduction

For any dental practice, two of the most time-consuming administrative tasks are verifying patient insurance and posting payments from EOBs and ERAs. A slow or inaccurate process in either of these areas can lead to claim denials, delayed payments, and a negative patient experience. As practices look to automate, they often encounter different types of solutions. Understanding the key differences in how platforms like <u>Toothy</u> and Rectangle Health approach these tasks is crucial to choosing the right fit for your practice's needs.

Key Takeaways

• The primary goal of automation is to eliminate the costly errors and time spent on manual verification and payment posting.
• Effective insurance verification must account for both modern insurance companies with digital portals and older payers that still require phone calls.
• Efficient ERA posting relies on seamless integration with your Practice Management Software (PMS) to ensure accuracy and speed.
• The best solution for your practice depends on whether you need a system focused on digital patient engagement or one designed for comprehensive, end-to-end revenue cycle automation.

Comparing Two Approaches to RCM Automation

To understand the difference between <u>Toothy</u> and Rectangle Health, it's helpful to look at their core focus. Rectangle Health is a powerful tool for patient-facing interactions and payments, while <u>Toothy</u> is a specialized AI assistant for the entire back-office insurance revenue cycle. This difference in focus leads to distinct approaches for verification and ERA posting.

1. The Process for Insurance Eligibility Verification

The biggest challenge in verification is that not all insurance companies are created equal. Some offer modern, real-time connections (APIs), while many still require a staff member to log into a clunky web portal or, worse, make a phone call. An effective solution must address this fragmented landscape.

• A platform like Rectangle Health, with its Practice Management Bridge®, excels at streamlining the digital part of this process. It is designed to connect with your PMS and electronically verify eligibility for payers that have modern digital connections. This can cover a significant portion of a practice's patient base, reducing the manual workload for the most common insurance plans and creating a smoother, faster front-office experience for those specific transactions.
• A platform like <u>Toothy</u> is designed to <u>handle both digital and non-digital verifications</u> by <u>integrating with your PMS</u>. Its system first attempts an electronic check. However, it is built to solve the "last mile" problem for the insurance companies that don’t have a reliable portal or require a phone call. For these, Toothy’s AI voice assistant <u>automatically makes the call on your team's behalf</u>. This is a key differentiator designed to ensure that 100% of your patients can be verified without your staff ever having to wait on hold. It addresses the reality that a partially automated system still leaves a significant manual burden on the front office team.

2. The Process for ERA Posting and Reconciliation

After a claim is paid, the final step is posting the payment from the Electronic Remittance Advice (ERA) or a paper EOB back into your PMS. This needs to be done accurately to close the claim and bill the patient for any remaining balance. A manual process here is slow and a major source of financial errors.

• Both platforms are designed to automate the core task of payment posting by integrating with your PMS. They can receive electronic remittance files and automatically post the payments to the correct patient ledgers. This significantly reduces the chance of human error compared to the tedious process of manually matching line items and entering payment data.
• The primary difference often lies in how exceptions and the next steps in the revenue cycle are handled. A specialized RCM platform like <u>Toothy</u> is built to manage the entire financial lifecycle, not just the payment transaction. This means its system is not only posting the payment but also analyzing it for discrepancies. It is designed to identify underpayments or denied line items and automatically flag them for appeal. The focus is on closing the loop on the entire claim journey, from submission to final payment reconciliation and denial management, ensuring that no potential revenue is left behind.

FAQ Section

1. What is the main difference between a patient engagement platform and an RCM platform? A patient engagement platform (like Rectangle Health) is typically focused on the patient-facing parts of your practice, such as digital intake forms, appointment reminders, and patient payments. An RCM platform (like <u>Toothy</u>) is focused on the back-office financial workflow with the insurance companies, such as claims management, denial appeals, and payment posting.

2. Why are AI voice agents important for insurance verification? AI voice agents are important because many dental insurance companies, especially smaller ones, do not have modern digital portals (APIs) that allow for real-time electronic verification. In these cases, a phone call is the only way to get a complete and accurate benefits breakdown. An AI voice agent can make these calls automatically, ensuring all patients can be verified without burdening your staff.

3. Does automating ERA posting mean my team doesn’t have to do anything? Automation handles the vast majority of the repetitive data entry. However, your team is still essential for overseeing the process and managing the exceptions. For example, if a claim is denied, the system will flag it, but a skilled biller may need to provide additional clinical information to win the appeal. The goal of automation is to free your team up to focus on these high-value, problem-solving tasks.

Conclusion

The right automation partner for your practice depends on your primary goals. If your focus is on improving the digital patient experience and streamlining patient payments, a platform like Rectangle Health offers a robust solution. However, if your primary goal is to create a truly hands-off, end-to-end insurance revenue cycle that can handle 100% of your verifications and manage the entire claims lifecycle, a specialized AI assistant like Toothy.ai is built to address that specific challenge.

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