5 ways DSOs can automate RCM with Stedi

Running a dental practice means running a business: IT, HR, marketing, and revenue cycle management (RCM).

To focus on care, many dental providers hand off RCM and back-office work to a Dental Service Organization (DSO). Because a DSO serves many providers, it can offer specialized services and operate at a scale most practices can't match.

The problem is that many DSOs still rely on tools built for small practices. For example, DSO staff verify patient insurance by logging into separate portals for every payer. Those manual workflows become a bottleneck as a DSO adds more providers, payers, and states.

As a programmable healthcare clearinghouse, Stedi gives DSOs APIs and tools to automate RCM workflows across providers and thousands of payers – reliably and at scale.

Tip: Use a coding agent

Stedi is designed to work well with AI coding agents, like Claude Code and Codex. These tools can cut your integration time. For example, you can use a coding agent to build an insurance verification app with Stedi in less than 30 minutes.

To get started, point your agent at Stedi's plain-text docs and OpenAPI specs. You can then use the agent to build scripts or apps that integrate with Stedi. The agent can use Stedi’s mock eligibility check workflow and test claims workflow to test the integration end to end without using real patient data or sending transactions to real payers.

For tips, see How to use Stedi with a coding agent.

1. Use real-time eligibility checks to verify insurance coverage

Many DSOs offer voice AI agents or call centers to handle inbound scheduling calls for providers. During these calls, providers and patients typically want answers to two questions:

• Will the patient’s insurance cover this visit?

• If yes, what payment should the provider collect from the patient before the visit?

Real-time eligibility checks let an inbound voice agent answer these questions while the patient is on the phone. The checks typically return a response in 1-3 seconds and cost pennies per request. Other automated methods, like portal scraping, take minutes.

That speed matters when coverage changes daily. For example, Indiana Medicaid refreshes its eligibility rosters daily. An automated real-time check on the day of service can confirm active coverage before the visit, which lets staff skip morning portal logins and payer calls.

Unlike payer portals, eligibility checks are standardized healthcare transactions. You run an eligibility check the same way for each payer. That makes eligibility checks easy to automate and scale. You can run real-time eligibility checks using Stedi’s JSON API, X12 API, SOAP API, or the Stedi portal.

To learn more, see our real-time eligibility docs.

2. Use batch eligibility checks to refresh patient coverage between visits

Many forms of dental care are recurring. For example, most dentists have patients return every 3-6 months for check-ups and cleanings – what they call recall.

A patient's insurance can change between those visits. Catching the change early lets the DSO reach out before the appointment. That heads off rejected and denied claims later.

Stedi's batch eligibility checks re-verify coverage and benefits for all your patients, or a subset, in one batch. DSOs can run these refreshes weekly, monthly, or annually by uploading a CSV in the Stedi portal or using Stedi’s Batch Eligibility Check API endpoint.

For more tips, see How to optimize monthly eligibility refresh checks and our batch eligibility checks docs.

3. Increase first-pass claim acceptance with claim edits

DSOs submit claims to many payers on behalf of many providers. The 837D – the HIPAA X12 standard for electronic dental claims – uses the same format for every payer, so a DSO runs one claims workflow instead of one per payer. With Stedi, you submit 837D claims over a JSON API; Stedi translates them to X12 for you. Many DSOs also bill medical, an increasingly important revenue driver in dental. Stedi handles those claims too: you submit the 837P professional claim over the same JSON API. If you already work in X12, submit over our X12 API or SFTP.

When a payer rejects a claim, the rejection often comes back hours or days later. That means the provider gets paid more slowly. It also means rework for the DSO, which has to fix and resubmit the claim. That rework multiplies as the DSO adds more providers.

To prevent rejections, Stedi runs every claim you submit through its database of claim edits and repairs before it reaches the payer. The edits validate the claim against the same checks the payer uses. The repairs fix what they can automatically. When a fix isn't possible, Stedi returns the error – in real time over the API, or within minutes over SFTP – so you can correct and resubmit before the payer's timely filing deadline.

With Stedi's edits and repairs, payers accept more claims on the first pass. Stedi customers often see first-pass acceptance rates of 95% or more, with the highest-volume customers exceeding 99%. The provider gets paid faster, and the DSO does less rework.

To learn more about how we create claim edits, check out our How we build our claim edits database blog post.

4. Automate provider onboarding with API-based transaction enrollment

To scale, DSOs constantly add providers and locations – a process called provider onboarding. One of its most tedious parts is transaction enrollment: registering a provider to exchange specific transactions with a payer. Payers always require transaction enrollment for ERAs. For other transactions, it varies by payer.

Most clearinghouses treat enrollment as a cost center and push the work back to you: filling out PDFs, chasing signatures, and checking portal statuses to onboard each provider, with a different process for every payer. At a DSO onboarding hundreds or thousands of providers, that adds up fast.

Stedi treats enrollment as part of the product. Where possible, we handle enrollment for you, removing 90% or more of the paperwork.

You can check enrollment requirements for each payer in the Stedi Payer Network or the Payers API. When enrollment is required, submit requests one at a time in the Stedi portal, in a bulk CSV, or through the Enrollments API. Once submitted, you can track the enrollment’s status by email, webhook, or API.

For payers that support one-click enrollment, you just need to submit the request; no other steps are required. If a payer requires a manual step – like a wet signature or a voided check – Stedi surfaces it as a task you can complete in the API or the Stedi portal.

For more, see our transaction enrollment docs.

5. Track reconciliation with ERAs

After a payer processes a claim, it sends back a remittance that says what it paid, what it didn't, and why.

If a provider doesn’t have a clearinghouse on file with the payer (set up through transaction enrollment), the payer mails or emails the provider the remittance as an explanation of benefits (EOB) or explanation of payment (EOP). If there’s a clearinghouse on file, the payer sends the clearinghouse an Electronic Remittance Advice (ERA).

To keep the books current, a DSO matches the payments in each remittance back to the original claim, a process called reconciliation. When done by hand using EOBs or EOPs, reconciliation is time-consuming, which means it’s expensive. At a DSO, those costs compound with each new provider and location.

With Stedi, you can be notified through a webhook, SFTP, or API polling as soon as a new ERA arrives. When it does, you can fetch the actual ERA content as JSON using our ERA Reports API. You can then programmatically correlate the patient control number for each payment in the ERA back to the original claim. That lets the DSO automatically post, reconcile, and report on payments across practices.

Get started with Stedi

To get started with Stedi, sign up for a free sandbox account. It takes less than two minutes. No credit card is required.

Sandbox accounts give you access to mock eligibility checks you can use for testing or integration.

When you’re ready, upgrade to production on our pay-as-you-go plan. There are no monthly minimums or setup fees. You only pay for the transactions you use.