Real-world scenarios where our APIs drive compliance, engagement, and cost savings
Deploy CMS-required Patient Access and Payer-to-Payer FHIR APIs to meet regulatory deadlines
CMS mandates require dental payers to implement FHIR R4 APIs by specific deadlines. Building this infrastructure from scratch requires 12-18 months of engineering effort, specialized FHIR expertise, and ongoing compliance monitoring. Most payers face resource constraints and tight timelines.
Our pre-built FHIR platform includes 26 resource types with US Core profile validation, SMART on FHIR authorization, and multi-tenant isolation. Deploy in weeks instead of months. Built-in audit logging and compliance reporting reduce ongoing maintenance burden.
Deploy production-ready FHIR APIs in 4-6 weeks instead of 12-18 months of custom development
Avoid hiring specialized FHIR developers and infrastructure engineers for a one-time mandate
Stay current with evolving CMS requirements through managed platform updates
6-year audit logging built-in for HIPAA compliance and regulatory reporting
Embed instant oral health scoring into member portals to drive preventive care utilization
67% of members skip preventive dental visits until problems become painful and expensive. Member portals exist but lack interactive tools that create urgency around preventive care. Members need instant feedback to take action before small problems become major claims.
Integrate our dental image analysis API into your member portal or mobile app. Members upload a dental photo and receive cavity risk, gum health, plaque level, and overall oral health scores in 3 seconds. High-risk members are automatically flagged for follow-up campaigns.
3-second response time enables in-app instant feedback that drives immediate member action
Members with high cavity risk scores schedule cleanings before problems require crowns or root canals
Track member oral health trends over time to improve HEDIS dental quality metrics
Early detection prevents $2,000 crowns by catching issues at the $150 filling stage
Power virtual dental screening and triage workflows to reduce unnecessary ER visits
Members with dental emergencies often visit expensive ERs because they can't get immediate dental care. Teledentistry programs exist but lack diagnostic tools to assess urgency remotely. Dentists need objective data to prioritize high-risk cases.
Members submit dental photos before virtual consultations. Our AI provides pre-visit risk assessment with cavity risk and gum health scores. Dentists use these scores to triage cases, prioritize urgent appointments, and provide clinical decision support during virtual visits.
Dentists review AI scores before appointments to prepare appropriate treatment plans
Members with low-risk scores receive virtual guidance instead of costly ER visits
High cavity risk scores automatically move members to urgent appointment slots
Track member oral health changes over time between in-person visits
Target SMS outreach based on AI oral health risk scores to drive preventive visit rates
Generic "schedule your cleaning" campaigns have low response rates because members don't perceive urgency. Without personalized risk data, payers can't target high-risk members who would benefit most from immediate preventive care.
Use dental AI scores to segment members by risk level. Send targeted SMS campaigns to high cavity risk members with urgent messaging. Track which campaigns drive appointments and measure ROI through claims data. Automated eligibility verification ensures messages only reach active members.
Members with high AI scores receive urgent "cavity risk detected" messaging instead of generic reminders
Welcome, referral, utilization, and holiday campaigns run automatically with eligibility checks
Track preventive visit rates and claims costs per campaign to measure effectiveness
Personalized engagement increases member satisfaction and reduces churn
Seamlessly exchange member clinical and claims data when members switch insurance plans
When members change insurance plans, new payers have no visibility into past dental history. This leads to redundant treatments, delayed care, and member frustration. CMS-0057-F mandates require payers to exchange this data via FHIR.
Our FHIR platform includes $member-match operation for patient matching and $everything operation for complete data bundles. Supports mutual TLS for secure payer-to-payer connections. Exchange Patient, Coverage, EOB, and clinical resources automatically when members switch plans.
New payers receive complete member history including past treatments and claims
Dentists access prior dental work to avoid redundant X-rays and unnecessary procedures
Members don't have to manually request records or repeat medical history
Meet CMS-0057-F payer-to-payer data exchange requirements automatically
Streamline preauthorization workflows with FHIR-based submission and status tracking
Prior authorization for expensive dental procedures (crowns, implants, orthodontics) involves manual faxing, phone calls, and long wait times. Providers and members lose track of approval status. Delays in authorization lead to delayed care and member complaints.
Providers submit preauthorization requests via our FHIR Claim API with use="preauthorization". $submit operation processes requests and returns ClaimResponse with approval/denial status. $inquire operation allows real-time status queries. All interactions tracked in audit logs.
Synchronous $submit responds within 5 seconds for straightforward approvals
Providers and members check authorization status via API instead of calling
Structured FHIR format ensures all required clinical documentation is submitted upfront
Provider EHR systems integrate directly with API to eliminate manual data entry
Schedule a demo to discuss your specific payer challenges
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