Resolve payment exceptions before balances grow.
Failed installment payments are noticed late.
Est. deploy 4–6 weeksSee the walkthrough
Back Office & Finance · Dental
Prepare cleaner claim resubmission packets.
Staff rebuild denied claims from scattered documents.
For: Billing leads and the team responsible for back office & finance in dental.
01 · The outcome
What good looks like.
The team has a resubmission packet for billing and clinician approval, with source evidence and an explicit approval before any external action. Track time to prepare a complete resubmission against a baseline; do not assume automation improves it.
A connected workflow that uses denial reason, submitted claim, and authorized supporting records to map the stated denial reason to missing administrative evidence without altering clinical codes. It produces a resubmission packet for billing and clinician approval.
Where AI helps, and where a person decides.
AI can map the stated denial reason to missing administrative evidence without altering clinical codes. It drafts and organizes; it does not authorize spending, commitments, clinical decisions or customer communication. The billing lead verifies the source facts and approves the final action.
Billing lead is accountable. People approve customer-facing, sensitive, financial, and legally binding actions.
- Billing lead: Capture the source and scope
- Billing lead: Review the proposed outcome
- Billing lead: Release only the approved version
- Billing lead: Check the result and exceptions
A named person approves customer-facing messages, spending, record changes and binding commitments before release. Pre-approved scripts are versioned; exceptions stop for review.
02 · The handoffs
How the work moves.
Every handoff has an owner. Select a step to open or close its detail.
Start when: A claim denial arrives. Connect only denial reason, submitted claim, and authorized supporting records. The billing lead confirms the request is authorized and in scope.
Ready when: The source reference, permissions and accountable owner are recorded.
Use the authorized records to map the stated denial reason to missing administrative evidence without altering clinical codes. Preserve the original language alongside the draft and label uncertain fields.
Ready when: Each proposed fact links back to a source, and missing information is visible.
Check a resubmission packet for billing and clinician approval against the original records and current policy. Correct errors and escalate exceptions to the qualified specialist; do not auto-approve.
Ready when: Billing lead has recorded approval or a reason to hold the item.
After explicit approval, save a resubmission packet for billing and clinician approval in the system of record. Send only approved messages to verified recipients. Record the version and prevent duplicate delivery.
Ready when: The approved record is saved; any delivery is confirmed or placed in the retry queue.
Review time to prepare a complete resubmission each week, sample completed records for quality, and resolve held items. Change the rules only after reviewing actual errors and staff feedback.
Ready when: Exceptions have owners, the metric has a baseline, and corrective actions are assigned.
Sample record.
$ david run --workflow=dental-claim-resubmission
ILLUSTRATIVE RECORD / NOT LIVE CUSTOMER DATA
- Example
- Illustrative only — not a real client record
- Reference
- DENTAL-CLAIM-RESUBMISSIO-DEMO-001
- Trigger
- A claim denial arrives.
- Owner
- Billing lead
- Prepared output
- a resubmission packet for billing and clinician approval
- Review status
- Awaiting human approval — no external action taken
- Missing information
- Owner to verify source completeness
- Measure
- Time to prepare a complete resubmission
Start with your tools.
Connect Practice management system, Eligibility portal, Secure messaging through approved APIs or controlled exports. Map record identifiers first; test permissions and field updates in a sandbox. Vendor names describe possible connections, not a guarantee of an available integration or license.
When things go wrong.
- A named person approves customer-facing messages, spending, record changes and binding commitments before release. Pre-approved scripts are versioned; exceptions stop for review.
- Use only authorized sources and role-based access. Keep an audit trail of source records, drafts, approvals and delivery status; deduplicate retries.
- If an integration fails, a source is missing or confidence is low, pause the action and assign the original request to the accountable owner.
- For healthcare uses, validate HIPAA applicability, execute required BAAs, restrict PHI to the minimum necessary, and use approved secure systems. Clinicians handle symptoms, urgent care and clinical decisions.
Try this week / no DAVID required
A useful first step.
This week, have your billing lead time five examples of this work. Use redacted copies of denial reason, submitted claim, and authorized supporting records to make a resubmission packet for billing and clinician approval manually, then list which fields required judgment.
What to measure.
- Time to prepare a complete resubmission
- Minutes of human handling per completed item
- Drafts needing substantive correction
- Exceptions unresolved beyond the agreed review window
Estimate your time back.
20.8
$11,232
03 · More workflows to consider
Related workflows.
Find recurring causes of claim denials.
The same preventable denial keeps returning.
Est. deploy 4–6 weeksSee the walkthrough
Check billing narratives before invoices leave.
Invoices contain vague entries or privileged details.
Est. deploy 4–6 weeksSee the walkthrough
Want this running in your business in 4–6 weeks?
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