Lumina Dental Network Billing Automation
A nine-branch Metro Manila dental network automated PhilHealth, HMO routing, and patient statements.
Impact
What changed.
Statement velocity
Patient statements now go out on schedule, every cycle, without manual assembly. Average days-sales-outstanding on patient AR dropped 28 days.
Claim rejection rate
PhilHealth and HMO claim rejection rate fell from 18% to 5% as procedure-code validation caught issues before submission instead of after.
Branch expansion
The network opened three additional branches without adding billing headcount. The four-person team now supports twelve clinics.
The challenge
Before
Lumina Dental runs nine branches across Metro Manila with roughly 18,000 monthly patient visits split across PhilHealth, six HMO networks, and self-pay. Billing was the most fragile part of the operation — each HMO had a different claim format, PhilHealth submissions slipped because procedure-coding mistakes were caught only at rejection, and patient statements went out late because billing staff were swamped with payer reconciliation. The group had four full-time billing staff and an obvious ceiling on branch growth without proportional headcount.
- 18,000 monthly visits routed across PhilHealth, six HMOs, and self-pay
- Each HMO claim format different, prepared manually per submission
- PhilHealth procedure-coding mistakes caught only at rejection, weeks later
- Patient statements sent late as billing staff drowned in payer reconciliation
- Branch-level claim status invisible to clinic managers
- HMO eligibility verification done by phone, often per-visit
- Denied claims followed up manually with inconsistent persistence
- Four-person billing team capping further branch expansion
The solution
What we built
We built a billing automation layer over the existing dental practice management system. Every patient visit flows through structured procedure-code capture at the chairside. Eligibility verification against PhilHealth and HMO portals runs automatically at appointment booking and is re-checked the morning of the visit. Claim packets generate in each payer's required format and submit through API or RPA depending on payer. Rejections route back into a structured queue with reason coding so billing staff fix root causes, not symptoms. Patient statements generate on a defined cycle without human assembly. Branch-level dashboards show claim status, AR aging, and payer mix in real time. The agent does not make clinical or coverage judgments — it removes the assembly, follow-up, and chasing work that was consuming the team.
Core workflow connections
How the system flows.
- Visit BookedEligibility VerifiedCoverage Confirmed
- Morning Re-checkEligibility RefreshPatient Notified if Changed
- Visit CompletedProcedure Codes CapturedClaim Packet Drafted
- Claim SubmissionAPI or RPAConfirmation Tracked
- RejectionReason CodedFix QueueResubmission
- Patient Statement CycleGenerationChannel Delivery
- Branch DashboardClaim Status + AR Aging + Payer Mix
- Denied Claim Follow-upStructured PersistenceEscalation
- Multi-payer formatting handled per payer requirement
- Clinical and coverage judgments retained by clinicians and billing leads
Process
How we built it.
Visit Booked → Eligibility Verified → Coverage Confirmed
Morning Re-check → Eligibility Refresh → Patient Notified if Changed
Visit Completed → Procedure Codes Captured → Claim Packet Drafted
Claim Submission → API or RPA → Confirmation Tracked
Rejection → Reason Coded → Fix Queue → Resubmission
Patient Statement Cycle → Generation → Channel Delivery
Branch Dashboard → Claim Status + AR Aging + Payer Mix
Denied Claim Follow-up → Structured Persistence → Escalation
Multi-payer formatting handled per payer requirement
Clinical and coverage judgments retained by clinicians and billing leads
Start a project
Multi-payer billing capping your growth?
We build healthcare billing automation that respects payer-specific quirks and your billing team's expertise — they do the judgment work, the assembly is automated.
No retainer lock-in · Month-to-month · Full transparency
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