PPO Advisors provides dentists with a risk-free analysis of their Preferred Provider Organization (PPO) participation. Through custom PPO negotiations, they help clients get higher fee schedules with each insurance company. That leads to revenue growth and write-off decrease for dental offices.
The Case
Challenge
In the world of dental insurance, many things are not as clear as day, even for dental providers. To attract more patients, dental offices expand their insurance network and participate with multiple organizations either through direct contracts or through umbrella companies. In every particular case, chances are one form of contract is more profitable than the other.
Our Client works with many top-rated insurance companies, like Aetna, Guardian, Cigna, Metlife, or Ameritas, and umbrella companies, like Zelis or Careington.
Helping clients make the most of each contract, PPO Advisors analyzes and compares numerous current fee schedules with possible alternatives.
The data obtained from dental providers and insurance companies came in the form of cumbersome Excel and PDF docs — a large number of sheet tabs that took considerable time and effort to process manually. A particularly challenging subset of these documents was non-searchable PDFs: fee schedules and provider credentialing documents with no machine-readable text layer that could not be parsed through standard methods. Every data point had to be extracted by hand, and as document volumes grew, this became one of the most significant bottlenecks in the company’s workflow.
Moreover, there was no dedicated software to track and manage all customer relationships. As a result, a variety of records in different formats required manual data entry — the work the Client wanted to eliminate.
Process
Our team has precisely comprehended the Client’s pain points and prepared a step-by-step project plan that everyone agreed to follow iteratively.
The major goals were to automate document workflows, facilitate data processing, and empower the management of customer relationships. That’s where Velvetech’s expertise came into play.
Addressing the objectives mentioned above, the scope of work included:
- Implementation of CRM and Client Center for customer service
- Delivery of a custom middleware solution to process data
- Development and integration of an OCR-based document intelligence
- Development of a custom UI to generate reports
CRM Implementation
Having profound competence in CRM implementation and its integration with various enterprise software, Velvetech provided PPO Advisors with an effective solution for full-cycle service management based on a low-code automation platform.
Learn how Low-Code Helps Companies Automate Business
Together with the Client, we chose Creatio as a CRM software where the company can keep all customer data in one place, manage their requests, and track the document flows. Without a hitch, our team equipped PPO Advisors with Creatio Service Addition.
To achieve maximum value, the platform was integrated with the Client’s telephony to make and receive calls directly from the Creatio system.
Ultimately, the implementation of the Creatio CRM solution allowed PPO Advisors to:
- Have a 360-degree customer view
- Manage omnichannel communications
- Automate internal processes
Document Management Automation
Custom Middleware Software
As we’ve noted in the challenges above, the work with spreadsheets is the core instrument for the Client. Thus, it was vital to automate the analysis of practice and insurance documents and streamline further report creation – exactly what dental software solutions from Velvetech provide by eliminating manual bottlenecks.
To achieve this, Velvetech first built custom middleware. This solution processes, parses, and maps the required data. Following that, it compares fee schedules, allowing the company’s staff to easily choose the most profitable form of contract.
Sometimes, dental providers upload files as images instead of PDF or Excel formats, which leads to difficulties with data parsing. For that purpose, we developed a UI that PPO Advisors’ data analysts can use to insert data manually or select a template to fill out. As a result, it makes the parsing process seamless and efficient – a strong example of how dental software development services can transform operational efficiency for providers.
OCR and Document Intelligence for Non-Searchable PDFs
A significant portion of the documents PPO Advisors worked with, such as fee schedules and CAQH provider credentialing files, arrived as non-searchable PDFs and lacked an extractable text layer. Standard parsing approaches could not handle these files, and manual extraction was not sustainable at the volume the company was processing.
To solve this, we built an OCR-based document intelligence layer directly into the operational workflow. We conducted a head-to-head evaluation of Tesseract and ABBYY against the specific document types PPO Advisors handled — assessing accuracy, handling of varied layouts, and performance on low-quality scans. Based on that benchmarking, we selected the approach that delivered the most reliable extraction results for fee schedule tables and credentialing form fields.
The OCR pipeline was integrated into the existing parsing workflow so that non-searchable documents were processed through the same interface as standard files without requiring a separate manual step. Following deployment, we continued iterating on upload and parsing edge cases identified during live use, improving accuracy and reliability as the system encountered real-world document variability.
Custom-Built UI for Report Generation
Since it was essential to facilitate the report delivery, our team provided PPO Advisors with another functionality — a custom-built UI for report generation. With just a click of a button, it creates a report that contains tabs with summary data, comparisons, and multiple transition options. Besides, it shows the annual revenue growth that dental providers could achieve.
Book Generation Tool
When dental offices receive a report, they consider the benefits of partnering with insurance companies through suggested forms of contract. After they choose an alternative option, it is time to carry out a transition.
In order to make sure the transition goes smoothly, PPO Advisors generates the necessary documents and instructions. Velvetech helped the Client automate this process. Now, PPO Advisors is empowered with a tool that allows them to create comprehensive files and recommendations with just one single move.
Client Center Development
Lastly, we’ve helped the Client facilitate collaboration with their customers by developing a brand new Client Center. It is a unified point of entry for PPO Advisor’s clients to initiate the analysis of practice and insurance documents.
From now on, dental providers will be able to insert necessary data, upload the files, electronically sign the docs, and follow the progress status. A tailored Client Center brings great potential for the company to win more customers and significantly enhance their experience.
Outcome
The implementation of CRM allowed the Client to store all the important data about their customers in one place, keep track of interactions with them, manage multichannel communications, and have a better view of the document flow.
By leveraging our dedicated software product engineering services, the solution enabled PPO Advisors to eliminate manual work and error possibilities, save time, and speed up report generation. The OCR pipeline removed one of the most persistent manual bottlenecks in the company’s workflow — non-searchable fee schedules and credentialing documents are now processed automatically and fed directly into the parsing and comparison workflow. Moreover, the software we developed enabled the top dental insurance consultant to enhance overall efficiency and improve customer experience.
The solution implemented by Velvetech uniquely positioned PPO Advisors to stand above the competition in the Dental Provider Credentialing and Insurance Contracts negotiation industry in the US. It helped the company become the only one that is process-driven from start to end.
Ultimately, the Client Center solution we provided the company with has served as a springboard or trampoline to accelerate their business and boost their advantage. It was this advantage that resulted in a six-figure contract PPO Advisors won to work with a large Dental Service Organization for the next few years.
What’s Next
Every stage of our collaboration with PPO Advisors spilled over into new opportunities for its business. Our partnership will continue further and provide the Client with new functionality for Provider Credentialing and Recredentialing Processes. This will become a starting point for a new line of PPO Advisors’ business development.
