Book a Demo
Front-Office RCM from Suggestic · Built on The Foundation Method™

The capacity of an extra FTE.
At every clinic.

Suggestic verifies insurance eligibility across every payer your clinic sees, pulls claims history automatically, and writes results back into OpenDental — absorbing the workload of a full-time front-office role at every location. Live in production with a model multi-clinic DSO. Customer referrals available on request.

Book a discovery call See the customer story
Native integration Open Dental Multi-PMS roadmap: Dentrix · Eaglesoft · Dentrix Ascend
  • HIPAA
  • BAA available
  • SOC 2 Type II

Live in production · Multi-clinic DSO

Suggestic's front-office RCM runs in production with a model multi-clinic DSO, processing ~3,000 eligibility checks a month across the clinic network — verified against five major carriers and Minnesota Medicaid, written back to OpenDental in real time. Customer referrals available on request.

Serving DSOs Group practices Multi-clinic operators OpenDental-based practices Minnesota Medicaid Missouri Medicaid

Why this exists

Front-office insurance work doesn’t scale.

At a typical multi-clinic DSO, front-office staff spend 10–20 minutes per patient manually verifying insurance across carrier portals. Transcription errors, missed plan changes, and Medicaid portal sprawl turn into an entire FTE — every clinic, every month.

01 / Manual portal sprawl

Five carrier portals + state Medicaid. Per appointment.

Staff log into multiple carrier portals plus state Medicaid for every appointment. Results get transcribed into PMS notes — by hand, with errors.

02 / Discovered too late

Plan changes surface at the appointment, not before.

Coverage gaps and inactive plans appear in the chair — not in pre-visit verification. Revenue lost; rescheduling cost compounds.

03 / Fragmented history

Claims history scattered across portal logins.

Prior services, denied claims, and frequency limits live in carrier portals — often missing entirely from the PMS chart by the time the patient sits down.

04 / No PMS writeback

Verification lives in tabs and spreadsheets.

Results never land in OpenDental commlogs where staff actually work. Toggling between systems is the day job.

At 20 clinics, that’s ~$1.2M/yr of operational drag.
Illustrative · per-clinic FTE model

What it does

Three jobs. One platform. Operated by Suggestic.

Suggestic replaces front-office insurance work with a platform that runs on your OpenDental instance and inside your clinic operations — not on top of them.

01 / ELIGIBILITY VERIFICATION

Eligibility verification

Real-time + scheduled. Verifies coverage across every carrier and state Medicaid portal your clinics accept.

What you get

  • Active / inactive status with subscriber match
  • Copay, deductible, annual maximums, frequency limits
  • Network status surfaced pre-appointment
  • Written into the OpenDental commlog within minutes of scheduling
TODAY · Verified against five major carriers + MN Medicaid in production. Missouri carriers (eMOMED, Envolve, DentaQuest, Dental Hub) opening Q3 2026.
02 / CLAIMS HISTORY RETRIEVAL

Claims history retrieval

6-layer audit trail. MN-ITS data, claims history, alternate insurance, alerts, spenddown, and a normalized summary — assembled into a single PMS-readable commlog body.

What you get

  • Pre-appointment visibility into prior services
  • Denied claims and frequency limitations surfaced
  • Waiting periods and alternate insurance discovered
  • Spenddown status surfaced for Medicaid populations
TODAY · 6-layer audit live with our reference DSO; MN-ITS in production. Multi-state expansion follows carrier API roadmap.
03 / PMS-NATIVE WRITEBACK

PMS-native writeback

Lands where staff already work. OpenDental commlog body + InsVerify date set automatically. Color-coded status: Green · Orange · Purple.

What you get

  • Zero context-switching for front-office staff
  • Eligibility visible inside the patient chart
  • InsVerify date set on every verified record
  • Nine standardized flag types route exceptions cleanly
TODAY · OpenDental writeback in production. Dentrix, Eaglesoft, Dentrix Ascend integrations on the SaaS roadmap (June–September 2026).

How it works under the hood

Every payer, every channel.

Carriers vary wildly in API maturity. Some have clean REST endpoints; some have only a portal and a captcha. Suggestic’s four-tier architecture handles all of them — and gets faster as the carrier ecosystem matures.

L0
Browser automation Browserbase + Playwright
Portal-only carriers and state Medicaid (MN-ITS, eMOMED).
~30–90s / check
L1
Hybrid · login + API Auth-gated API fetch
Carriers with auth-gated APIs (Delta, DentaQuest).
~10–20s / check
L2
Pure API OAuth · REST
Modern carriers with open API + OAuth endpoints.
<5s / check
L3
Clearinghouse EDI X12 270/271 · roadmap
Multi-state scale (Vyne · DentalXChange · Change Healthcare · Availity).
<2s / check · batch

You don’t pick a tier. Suggestic picks the best available channel per carrier per check and routes accordingly. As carriers add APIs, the platform upgrades silently — no operational change for the clinic.

What your staff sees

Every check, every flag, every audit line — in OpenDental.

The platform writes back into your OpenDental commlog the same way a verified team member would — except every step is logged, color-coded, and re-runnable.

A / Color-coded status

Front-office surface, at a glance.

GreenActive · Done · No action needed.
OrangeAttention · One of nine flag types triggered.
PurplePending · Not yet verified.
STATUS · Visible in the OpenDental commlog list. Color first; click for detail.
B / Nine standardized flag types

Each flag is a routing decision.

01Plan mismatch
02Inactive coverage
03Subscriber info change
04System error
05Spenddown required
06Frequency limitation
07Network status mismatch
08Alternate insurance found
09Manual review requested
FLAGS · Surfaces what needs a human. Everything else lands in OpenDental ready to use.
C / 6-layer audit trail

In the commlog body. Replayable.

L1MN-ITS data
L2Claims history
L3Alternate insurance
L4Alerts
L5Spenddown
L6Normalized summary
AUDIT · Auditable, replayable, exportable. Billing teams get the full picture in one place.

Reference customer · anonymized

A model DSO added the capacity of an FTE at every clinic.

Customer name held in confidence at the customer’s request. Direct referrals — including reference calls with the DSO’s operations leadership — available on request during a discovery call.

Reference · Multi-clinic DSO · Minnesota

Front-office work, automated end-to-end on OpenDental.

Multi-clinic DSO operating across Minnesota, running OpenDental as the practice management system. Front-office staff at each location previously carried the full workload of insurance eligibility verification and claims-history retrieval — typically a full-time role per clinic dedicated to this work, with little capacity left for the operational tasks staff are actually hired to do.

Deployed Suggestic in early 2026. By April, the platform was running ~3,000 eligibility checks per month across the network, with verified results writing back into OpenDental commlogs in real time. Verified against five major carriers plus Minnesota Medicaid (MN-ITS).

In May 2026, a claims-history enrichment pipeline failure was identified in production. Suggestic shipped four fixes within nine hours. Zero downtime for the clinic network during incident response. The reliability pattern matches the engineering bar — 743+ regression tests, 33 PRs merged in 37 days, production on Kubernetes + Google Cloud.

“AI is as close as you can get to heaven in the dental world. The ability to move this rapidly is a testament to the team’s professionalism and experience.”

— Operations leadership · multi-clinic DSO · May 2026

~3,000/mo
Eligibility checks verified across the clinic network.
Measured · reference DSO · April 2026
+1 FTE
Per-clinic front-office capacity added (~$60K/year fully loaded).
Measured · per-clinic at the reference DSO
0
Production outages or PHI escalations across deployments.
Observed · all engagements to date

Proof

Outcomes that compound.

Each metric carries its provenance — what we observed in production, what was independently measured at a customer, and what is illustrative of the per-clinic pattern at multi-clinic scale.

~3,000/mo

Eligibility checks verified at our reference DSO across the clinic network.

Measured · live production
+1FTE

Per-clinic front-office capacity added (~$60K/year fully loaded).

Measured · reference DSO
~$1.2M/yr

Operational drag eliminated at a 20-clinic DSO scale.

Illustrative · modeled on per-clinic
<4mo

Typical payback period at DSO scale.

Illustrative · model
743+

Regression tests in the production codebase.

Observed · engineering bar
99.5%

Contractual uptime SLA across customer deployments.

Contracted · SLA

How we operate

Governance, compliance, transfer.

Three things DSOs ask before they buy. Three things we’ve engineered into the platform from day one — not bolted on at audit time.

Governance

Every eligibility check is logged, replayable, and auditable. No black boxes touching PHI.

  • Versioned audits on every payer connector (L0–L3)
  • Full provenance log on every commlog writeback
  • Human-in-the-loop review gates via the nine flag types
  • Carrier-response replay for compliance review

Compliance

Operating under the controls regulated dental workflows require.

  • HIPAA-aligned operations · BAA available
  • SOC 2 Type II certified
  • Zero-trust · SSO · RBAC · encryption at rest and in transit
  • Data isolation for multi-tenant scaling (Missouri trial readiness)

Transfer

Suggestic operates the platform today. When your team is ready to take it over, the path is clean.

  • Eligibility data, audit trails, and PMS writebacks are yours throughout
  • Platform runtime transfer available on request
  • Documented runbooks, IaC, and on-call procedures hand-off ready
  • Joint operations period until your team is comfortable

Why this scales

This is the first dental system on Suggestic’s foundation. Not the last.

Every Suggestic engagement ships on a shared, productized architecture — private data layer, governance, model orchestration, compliance controls.

The Foundation Method™ means new systems on the same foundation ship 50–70% faster than the first. For DSOs, that means the next dental system — payment posting, denials triage, prior-auth automation, member engagement — won’t require a new vendor or a new audit.

Read The Foundation Method

Common questions

Frequently asked.

What PMS does Suggestic integrate with today?

OpenDental, in production at our reference multi-clinic DSO. Multi-PMS roadmap covers Dentrix, Eaglesoft, and Dentrix Ascend (Phase 1 of the SaaS expansion, June–September 2026). The four-tier payer connectivity architecture is PMS-agnostic by design.

Which payers and Medicaid programs does the platform verify against?

Five major carriers plus Minnesota Medicaid (MN-ITS) in production today. Missouri carriers — eMOMED (MO HealthNet), Envolve, DentaQuest, Dental Hub — opening Q3 2026. The architecture supports adding new carriers as L0 (portal automation), L1 (hybrid), L2 (pure API), or L3 (clearinghouse) connectors.

How does Suggestic handle PHI and HIPAA?

HIPAA-aligned operations, BAA available, SOC 2 Type II certified. Zero-trust architecture: SSO, RBAC, encryption at rest and in transit, full audit log on every check. PHI stays within the customer’s data scope and never trains a shared model.

How much manual work does a DSO save in practice?

At our reference DSO, the platform adds the capacity of approximately one full-time front-office role per clinic — absorbing eligibility verification and claims-history retrieval so existing staff can focus on patient-facing and revenue-cycle work. At a 20-clinic DSO that models to ~$1.2M/year of operational drag eliminated (illustrative, based on a fully-loaded $60K/year FTE per clinic).

What’s the implementation timeline?

A typical clinic onboarding is 30 days end-to-end. Includes a plan-mapping workshop (carrier names to state codes per your OpenDental instance), API key configuration, webhook routing, front-office and verification-team training, and a 30-day production hand-off. After clinic #1, additional clinics in the same DSO compound — Phase 1 of the SaaS expansion is explicitly built to make clinic #2 and beyond ship faster than #1.

What if a payer’s portal changes or breaks?

The L0 (browser automation) tier is monitored continuously. Carrier portal changes trigger a flag, the connector is updated, and the operational dashboard surfaces affected clinics. A May 2026 incident at our reference DSO — a claims-history enrichment pipeline failure — was fixed within nine hours with four shipped patches and zero clinic downtime.

Do you replace our clearinghouse?

No. The platform sits upstream of claims submission, verifying eligibility and pulling claims history. Existing clearinghouse relationships (Vyne, DentalXChange, Change Healthcare, Availity) remain in place. The L3 tier in the architecture is a future direct-EDI integration with clearinghouses for multi-state scale, not a clearinghouse replacement.

What does a Suggestic engagement look like commercially?

Implementation fee (one-time, per clinic) + monthly platform fee (volume-tiered, same rate for every customer). State enablement engineering (e.g., Missouri portal development) is absorbed as platform R&D, not customer cost. Launch Partner terms include a discount on Year 1 platform fees, exclusivity in the trial state for the trial period, and quarterly product roadmap input. Pricing is shared in the discovery call.

Get started

Front-end RCM, operated by Suggestic.

Start with a discovery call. We’ll walk you through the platform live in our reference DSO’s production environment, cover the integration and operational surface, and tell you whether your DSO is the right fit for the Missouri trial cohort — or for general availability when SaaS lands in 2027.

Book a discovery call
  • HIPAA
  • BAA available
  • SOC 2 Type II
  • Zero-trust architecture