The most boring AI use case is the one dentists actually want.

The numbers come from the CAQH Index, as reported by ADA News on the 2024 edition. “The largest increase in administrative spending in the dental industry came from eligibility and benefit verification spending, which increased by 15% to $2.1 billion” 2. That is not a vendor estimate. It is an industry measurement of what the work costs.

How does verification work? There are three ways. “Verification checks can be done fully electronically through an automated transaction that is mandated by the Health Insurance Portability and Accountability Act to meet certain standards; partially electronically through a plan portal; or manually by phone, fax, email or mail” 2.

The electronic transaction exists. So why do teams still log into portals and sit on hold? Mark A. Moats, D.M.D., chair of the ADA Council on Dental Benefit Programs, explained that “providers indicated in the CAQH Index that they often do not obtain robust enough information through the automated transaction to be reliable. These limitations have led to continued reliance on plan portals for verification, which can be more time consuming and costly for providers and their teams” 2. And the portals are not one thing. “The portals, which are maintained by insurance companies, vary in requirements and formats, making verification more complex, according to the report” 2.

What is on the table? “The potential cost savings of switching to automated electronic checks from portals or manual processes increased by 7% to $580 million for the dental industry” 2. The 2025 CAQH Index reports a “$1.9B Dental industry cost savings opportunity”, while noting that “In dental, lower transaction costs across modes reduced the overall savings opportunity” 3. Read those figures carefully. They come from different editions, and they describe the gap between manual or portal work and standard electronic transactions. They are not AI savings. The sources cited here do not show that AI closes that gap, and I will not pretend otherwise.

Here is what the data supports. Some dentists already use AI for verification, and about a third plan to 1. Across the wider healthcare industry, “More than half of plans and one-quarter of providers now use AI, with provider use focused on administrative tasks such as eligibility checks, note-taking, and patient communications” 3. That figure covers medical and dental together, so treat it as context, not a dental benchmark.

So, can AI do dental insurance verification? In my view, it can take on parts of the work inside a defined process, with a human handling the exceptions. I will not quote accuracy rates or minutes saved, because the published data I cite does not give them, and vendors’ own numbers are not evidence.

Why does it take so long? Because the automated transaction often does not return enough information to rely on 2. Because the fallback is a portal, and portals vary in their requirements and formats 2. Because the last resort is phone, fax, email or mail 2. The delay is structural. It lives in the data, not only in your front desk.

Outsource or automate? I think that is the wrong framing. Both are ways to buy the same thing: someone, or something, working your process. The questions are the same either way. Who owns the exception when a check comes back incomplete? Where does the result get recorded, and who can see it? What happens when a portal changes its format? What do we pay per verification, all in, and what did we pay before? If the answer to any of those is “the vendor handles it”, you do not have a process. You have a hope.

What goes on the form? In generic terms: the plan, the subscriber, eligibility status, and the categories of limits the plan applies, such as frequency limits. The specific fields depend on your practice and your software. [DA VERIFICARE: generic verification form fields, no public source cited] What a patient will owe is a separate conversation, and not one I am giving advice on here.

Verification touches patient information. That changes the vendor’s legal status. HHS is explicit: “When a covered entity engages the services of a CSP to create, receive, maintain, or transmit ePHI … on its behalf, the CSP is a business associate under HIPAA” 6. So ask whether the vendor signs a business associate agreement. No BAA, no deal.

Do not accept the phrase “HIPAA compliant” on a sales page as a seal. HHS does not certify products. In the agency’s words, “OCR does not endorse, certify, or recommend specific technology or products” 6. A vendor can describe its safeguards. It cannot hand you a government seal.

The FTC has its own question for anyone selling AI: “Are you exaggerating what your AI product can do?” 7 Ask the vendor to answer it in writing. Ask for proof, not promises.