Clairvance provides AI transformation consulting and implementation for medical, dental and other healthcare practices. We connect phones, scheduling, eligibility checks, prior authorizations and denials to the systems your practice already runs, with clinicians in control of every clinical decision.
Based in Seattle · Consulting and implementation across the U.S. · Remote and on site
Spend less of the front office’s day on hold, in portals and retyping forms.
A practice’s administrative day runs through phone lines, payer portals, fax queues and the practice management system, and the same patient details are often retyped at each step. We work with owners, practice administrators, billing leads and IT to map that work across providers and locations, then implement AI and integrations in the systems the practice already runs. Depending on the task, the answer may be an electronic transaction your clearinghouse already supports, a configured feature of your practice software or AI-assisted preparation with a person reviewing the result. Where a vendor will handle patient information, the business associate agreement and access rules are settled before anything goes live. Clinicians keep every clinical decision, and payers keep their coverage decisions.
Where transformation can start
The recurring work worth examining.
For owners, practice administrators, COOs and CFOs of established practice groups with several providers or locations: medical and dental groups, veterinary groups, physical therapy and outpatient clinics, and med spas. Bring one administrative workflow where volume has outgrown the front office or billing team.
The phone line is also the scheduling system
Calls to book, reschedule, check coverage or ask about a bill arrive on the same lines, and recall and reactivation outreach waits until the desk has time. An AI receptionist can handle routine booking and rescheduling inside the practice’s own scheduling rules and hand everything else to staff with the reason attached. In our implementations the agent does not assess symptoms or give advice; clinical questions go to clinical staff. A vendor that creates, receives, maintains or transmits patient information for the practice is a business associate under HIPAA, and HHS lists a third-party AI chatbot on a provider’s patient portal that handles appointment scheduling as one example.
A useful first move
Sort a week of calls by reason, location and time of day. Choose one call type with clear rules, such as rescheduling an existing appointment, and define the handoff for anything clinical, urgent or outside those rules before the agent answers a single call.
What to measure
Track abandoned calls, time to answer, calls resolved without a callback, scheduling corrections and handoffs by reason.
Intake and benefits checks happen too close to the visit
When intake forms, insurance cards and coverage details arrive the morning of an appointment, the front desk confirms them while patients wait. Eligibility already has a HIPAA standard electronic transaction for dental, professional and institutional care, the X12 270/271 inquiry and response, so the first question is whether your practice software and clearinghouse use it consistently. AI-assisted preparation can read uploaded forms and card images into a reviewed record and flag the coverage questions the electronic response left open. Staff confirm anything that changes what a patient is told about cost.
A useful first move
Pull a sample of recent visits for each location. Record when intake and coverage were confirmed, which items needed a portal check or a phone call, and which gaps reached the visit or the claim.
What to measure
Measure visits verified before the day of service, intake fields corrected at check in and claims denied for eligibility or registration errors.
Prior authorizations and referrals live in fax queues and payer portals
A prior authorization means gathering the order, chart notes and payer form, submitting through a portal or fax, then checking status until a decision arrives. Referrals move between offices the same way. A tracked workflow can assemble the packet from documentation clinicians already wrote, record each submission and surface requests nearing a deadline. The clinician decides what care is needed and the payer decides coverage; the workflow prepares paperwork and tracks status. Under CMS-0057-F, Medicare Advantage, Medicaid and CHIP payers must send decisions within 72 hours for expedited requests and seven calendar days for standard requests, with a specific reason for any denial, beginning in 2026.
A useful first move
List the services that most often need authorization, by payer and location. Follow a sample from order to decision, recording who assembled each packet, where it was submitted, how often the payer asked for more information and how long each step took.
What to measure
Track time from order to submission, time to decision by payer, requests for more information, denials by reason and visits rescheduled while waiting on an authorization.
Denials and payment posting are worked one exception at a time
Electronic remittance advice has its own HIPAA standard transaction, the X12 835, so the first check is whether your system already posts it automatically. The work that stays manual is the exception: a paper explanation of benefits, a payment that matches no claim, a partial payment or a denial that needs a corrected claim or an appeal. A denial workflow can group those items by reason and payer, gather the supporting documents and prepare a draft correction or appeal for staff review. Billing staff decide what is resubmitted, and clinicians review anything that rests on medical necessity.
A useful first move
Pull recent denials and unposted payments for each location. Group them by reason, payer and the step where the error began, then choose one category with enough volume and a clear fix to justify a working implementation.
What to measure
Measure denials by reason, days to resubmission, unposted payments and their age, appeal outcomes and amounts written off after missed filing deadlines.
Work with your operating reality
Your systems are part of the starting point.
We start with the practice management system, EHR or dental software, clearinghouse, phone system and payer portals you already use, and check which electronic transactions, APIs and imports each one supports. Before any vendor touches patient information, the practice confirms a business associate agreement that meets 45 CFR 164.504(e), and each step gets access only to the information it needs. The working deliverable includes the agreed rules, a review queue with the source document attached and a record of who approved each item. Acceptance cases cover a clinical question reaching the phone agent, a patient whose coverage changed, a remittance that matches no claim and a transfer that fails after submission. Front desk, billing and clinical leads test the complete path before rollout, with a named owner for rule changes.
Test partners against one shared packet and write data duties into the agreement before work starts.
Common questions
AI for medical and dental practices, answered.
What AI tools make sense for a medical practice?
Start with the administrative work that repeats every day: phone calls and scheduling, recall and reactivation, eligibility checks, intake forms, prior authorization paperwork, referrals, denials and payment posting. For each one, check what your practice management system and clearinghouse already do, then add AI where documents or conversations vary too much for fixed rules. Clairvance works only on the business and administrative side; clinicians keep every clinical decision.
Is it safe to use AI with patient information?
It can be, with the right agreements and controls, but no tool makes a practice compliant on its own. Under HIPAA (45 CFR 164.502(e) and 164.504(e)), a covered practice may share protected health information with a vendor only after obtaining satisfactory assurances, documented in a written business associate agreement. HHS treats a cloud provider that stores patient information as a business associate even if it holds only encrypted data and lacks the key. In Washington, the My Health My Data Act does not apply to information that meets HIPAA’s definition of protected health information, so health data a practice holds outside that definition needs its own review. This is general information, not legal advice; confirm the specifics with your counsel.
Can AI help a dental office with insurance verification?
Yes, as a preparation step with staff review. Dental eligibility and benefit inquiries have a HIPAA standard electronic transaction, the X12 270/271, so the first step is confirming what your practice software and clearinghouse already return. AI-assisted preparation can read insurance cards and intake forms, compare them with that response and flag the questions that still need a portal check or a call. Staff confirm anything that changes what a patient is told about cost.
Can AI help with prior authorizations?
It can prepare and track them; it does not decide them. A workflow can assemble the order, chart notes and payer form, record each submission and flag requests near a deadline, while the clinician decides what care is needed and the payer decides coverage. Under the CMS Interoperability and Prior Authorization final rule (CMS-0057-F), Medicare Advantage, Medicaid and CHIP payers must send decisions within 72 hours for expedited requests and seven calendar days for standard requests, and give a specific reason for a denial, beginning in 2026. The rule also requires a Prior Authorization API beginning January 1, 2027. Drugs are excluded.
Should a medical practice use an AI receptionist?
It can work for routine calls with clear rules, such as booking, rescheduling and confirming appointments, with a handoff to staff for anything clinical, urgent or unusual. In a Clairvance implementation the agent does not assess symptoms or give medical advice. A vendor that handles patient information for the practice is a business associate under HIPAA, and HHS lists a third-party AI chatbot on a provider’s patient portal that handles appointment scheduling as an example. In Washington, recording a call requires the consent of every participant, and a spoken notice counts only if the notice itself is recorded.
Start a conversation
Where does your front office lose the most time?
Tell us your practice management and phone systems, the locations involved and the administrative work your team chases most. Please leave patient information out of this form. We will use those details to discuss an implementation that fits your front office and billing team.
