Claims being denied because CDT codes aren't mapped correctly to the procedures your clinicians document?
Pre-authorisation for crown and implant work getting missed until the patient has already had the procedure?
Dental Billing Software Development
Dental insurance billing carries CDT code complexity, procedure-specific pre-authorisation requirements for major restorative work, and multi-carrier ERA reconciliation that generic medical billing tools were never designed to handle. Claims submitted without correct CDT code mapping are denied. Pre-auth for crowns and implants missed before scheduling creates write-off risk after the procedure is complete.
We build custom dental billing software for practices and DSOs. CDT code automation, pre-authorisation tracking, ERA and EOB processing, and patient billing -- built around the dental revenue cycle, not adapted from a medical billing template.
CDT code automation and claim generation
Pre-authorisation tracking for major restorative work
ERA and EOB processing with automatic payment posting
Patient billing portal and AR reporting
Custom dental billing software handles the full insurance revenue cycle for dental practices and DSOs -- CDT code mapping, real-time eligibility verification, claim submission to major carriers, ERA and EOB processing, pre-authorisation tracking for major restorative work, and patient statement generation. Unlike generic billing tools built for medical CPT workflows, dental billing software handles CDT code sets, tooth-level procedure documentation, and multi-carrier dental benefit structures. RaftLabs builds dental billing systems for practices and groups that need claim accuracy, pre-auth tracking, and AR visibility built into one system.
HIPAAAware architecture
·CDTCode automation
·FixedCost delivery
·12-14Week delivery cycles
Dental billing built around CDT codes, pre-authorisation, and ERA reconciliation
Dental billing is not a subset of medical billing with different procedure codes. CDT codes are structured around tooth number, surface notation, and procedure category in ways that CPT codes are not. A claim for a three-surface composite restoration requires the correct tooth number, the correct surface notation, the correct CDT code for the material used, and the correct fee schedule for that carrier -- and the combination of all four determines whether the claim pays or denies. Generic billing tools that treat procedure code as a single field do not handle this correctly.
Pre-authorisation is the second failure point. Major restorative work -- crowns, implants, bridges, and certain orthodontic treatments -- requires carrier approval before the procedure in most plans. A practice that schedules and completes that work without confirming pre-auth status is exposed to the full write-off risk when the carrier denies the claim post-service. Managing pre-auth manually across multiple carriers and treatment plans is a coordination problem that gets worse as practice volume grows.
ERA reconciliation adds a third layer. Electronic remittance files from dental carriers include claim adjustments, contractual write-offs, and patient balance calculations that must be posted accurately. When ERA processing is manual, posting errors create patient balance discrepancies that take months to unwind. Custom dental billing software handles all three problems in a single system built for the way dental billing actually works.
What we build
Insurance eligibility verification
Real-time eligibility checks via Change Healthcare or Availity before appointments are scheduled, not on the day of service. Benefit breakdown per patient covering preventive, basic, and major categories -- showing the plan's coverage percentages and applicable waiting periods. Annual maximum and deductible tracking updated as claims are paid throughout the benefit year so the front desk always has an accurate remaining benefit figure when presenting treatment fees. Coordination of benefits detection for patients with dual coverage, with secondary carrier benefit calculation included in the eligibility response. Eligibility check history stored against the patient record so re-verification at check-in is a confirmation step rather than a cold check.
CDT code and claim generation
CDT code mapping from procedure type, tooth number, and surface notation recorded in the clinical workflow -- the billing system receives structured procedure data and generates the correct code, not a human selecting from a dropdown. Claim generation with all required ADA claim form fields populated from the patient record, provider record, and procedure data. Multi-carrier electronic claim submission with carrier-specific formatting handled automatically. Modifier handling for procedures that require a modifier by carrier or by plan type. Claim scrubbing before submission to catch missing fields, tooth notation errors, and code combinations the carrier will reject -- denials identified before transmission, not after.
Pre-authorisation management
Pre-auth request tracking for crowns, implants, orthodontic treatment, and other major restorative work that carrier contracts require to be authorised before treatment. Treatment plan flagging at the scheduling stage -- if a procedure requires pre-auth and no approved auth exists on the patient record, the scheduler sees a warning before confirming the appointment. Auth approval status tracking with approval number, approved date, and limitation details stored against the treatment plan. Expiry tracking for authorisations with defined validity windows -- treatment planned against an auth that expired before the appointment date is flagged automatically. Pre-auth workflow integrated with treatment plan review so the clinical and front desk teams work from one record.
EOB and ERA processing
ERA file processing with automatic payment posting, contractual adjustment posting, and patient balance calculation after insurance payment is applied. Carrier-specific adjustment reason code mapping so write-off categories are applied correctly -- a contractual write-off for a network fee schedule posts differently from a denial for a missing pre-auth. EOB manual entry workflow for carriers that do not transmit ERA files, with the same payment and adjustment posting logic applied. Secondary claim generation triggered automatically when the primary carrier pays and a secondary benefit exists on the patient record. Patient balance after insurance is calculated and pushed to the patient account ready for statement generation -- no manual calculation required.
Patient billing and collections
Patient statement generation showing insurance payment received, adjustments applied, and balance due -- formatted for clarity so patients understand what they owe and why. Online payment portal accessible by link in the statement email or SMS, supporting card payments and ACH. Payment plan management with instalment schedule creation, automated instalment reminders, and payment tracking against the plan balance. Balance reminder automation at configurable intervals -- 30, 60, and 90 days -- with escalating message tone for aged balances. Collection workflow for balances past a defined age, with status tracking and escalation steps recorded against the patient account so the billing team has a complete collection history.
AR reporting and denial management
Aged receivables report by carrier and by patient showing balances in 0-30, 31-60, 61-90, and 90-plus day buckets -- so the billing team knows where the collection effort should go. Denial reason analysis showing the most common denial codes by carrier and by procedure category, with rework workflow to correct and resubmit denied claims from within the system. Collection rate by carrier showing what percentage of submitted claim value is paid within 90 days -- useful for identifying carriers with systemic underpayment or processing delays. Revenue per procedure category showing production and collection by CDT code group so practice leadership can see where the revenue is and where write-offs are concentrated.
Frequently asked questions
Dental billing uses CDT codes rather than CPT codes, and CDT code selection depends on tooth number, surface notation, and material type in ways that have no direct equivalent in medical billing. Dental insurance plans structure benefits around preventive, basic, and major categories with annual maximums, waiting periods, and frequency limitations -- which are different from medical deductible and out-of-pocket structures. Pre-authorisation requirements in dental are concentrated in major restorative procedures like crowns and implants rather than the broad inpatient and surgical auth requirements in medical. ERA processing in dental includes carrier-specific adjustment code sets that differ from the X12 standard used in medical remittance. Building dental billing on a medical billing platform means adapting each of these differences into a system that was not designed for them. We build dental billing systems from the ground up with CDT code logic, dental benefit structures, and dental pre-auth workflows as first-class features.
Claim submission integrates with the major dental clearinghouses -- Change Healthcare and Availity -- which provide access to Delta Dental, MetLife, Cigna, Guardian, Aetna, and most regional carriers. Eligibility verification uses the same clearinghouse connections. For ERA, we configure carrier-specific ERA enrollment for each carrier the practice works with -- ERA availability varies by carrier, and some smaller regional carriers still process EOBs manually. We confirm carrier coverage and ERA availability during project scoping based on your carrier mix. If you work with a carrier outside the standard clearinghouse network, we assess direct API availability or build a manual EOB entry workflow as the fallback.
Pre-auth is managed as a workflow step in the treatment plan, not a separate process. When a treatment plan includes a procedure that requires pre-auth -- crown, implant, bridge, ortho, or any procedure flagged as requiring auth by your carrier contracts -- the system creates a pre-auth task linked to that treatment plan. The task tracks submission date, carrier reference number, approval status, approved amount, and expiry date. If scheduling is attempted for a procedure with no approved auth on record, the scheduler sees a warning. If an approved auth exists but has expired, the same warning fires. Approved auth details are attached to the claim when it is submitted so the carrier can match the claim to the prior authorisation on file.
Yes, integration with existing practice management software is standard. The clinical and scheduling data recorded in your PMS -- procedures completed, tooth notation, provider, and patient details -- feeds into the billing system so claims are generated from accurate clinical records rather than re-entered by billing staff. Integration approach depends on your PMS: Open Dental has a documented open API, Dentrix and Eaglesoft have vendor APIs we work with, and other systems may require a data bridge. We confirm the integration method and data mapping during project scoping. If your practice uses a PMS with limited API access, we design an interface that minimises manual data entry while maintaining claim accuracy.
