> ## Documentation Index
> Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Overview: from first claim to smooth operations
> The daily, weekly, and monthly routines for dental billing, with initial payer, collections, receivables, and hygiene metrics.
Reliable billing depends on a small set of daily, weekly, and monthly tasks with named owners. This tutorial shows how Bluebird Dental could establish that operating cadence during the first 90 days after its first paid claim.
## What you're building
```mermaid theme={null}
graph TB
D[Daily
eligibility & benefits · charge entry
attachments · payment posting · rejections]
W[Weekly
denial & downgrade queue · AR review
credit balances · hygiene reappointment]
M[Monthly
close · reconciliation
management fee · KPIs]
D --> W --> M
```
Resolve problems close to the time they occur. A same-day rejection may involve one claim; the same configuration problem discovered at month-end may affect an entire batch.
## The daily rhythm
| Task | Who | Time |
| ----------------------------------------------------------------------------------------------------------------- | ---------- | --------- |
| Verify eligibility **and plan design** for tomorrow's schedule; remaining annual maximum, deductible, frequencies | Front desk | 30–45 min |
| Collect patient portions at checkout, from downgrade-aware estimates | Front desk | Ongoing |
| Enter charges for yesterday's visits | Biller | 30–60 min |
| Attach radiographs, perio charts, and narratives to the claims that need them, **with the initial claim** | Biller | 15 min |
| Clear scrubber edits and submit claims | Biller | 20 min |
| Work 999 / 277CA rejections, **same day** | Biller | 15 min |
| Post 835s and work the exception queue | Biller | 30 min |
| Confirm deposits match remittances | Biller | 15 min |
**Charges should be entered within one business day of the visit.** Every day of lag is a day added to days in AR and a day closer to timely filing limits.
## The weekly rhythm
| Task | Who | Cadence |
| ------------------------------------------------------------------------------------------------------------- | ----------------- | ------------------------- |
| Triage the adverse-835 queue: true denials to rework, downgrades and benefit-design limits to patient billing | Biller | Twice weekly minimum |
| Review AR aging, focusing on 60+ days | Biller + ops lead | Weekly |
| Review the credit balance report | Biller | Weekly |
| Review the **hygiene reappointment rate** and the unfilled hygiene chairs for the next two weeks | Ops lead | Weekly |
| Update the credentialing tracking grid | Ops | Weekly |
| Follow up on pending payer applications and predeterminations | Ops | Every two weeks per payer |
| Review unbilled encounters | Ops lead | Weekly |
Set a review deadline for every denial that is comfortably inside the applicable appeal window. Route benefit-design reductions, including valid downgrades, out of the denial queue once they have been classified. They usually require correct posting and patient communication rather than an appeal. See [Denials vs downgrades](/concepts/payments/denials-vs-downgrades).
## The monthly rhythm
| Task | Who |
| ----------------------------------------------------------------------------------------------------------- | ------------------- |
| Close both entities' books | Bookkeeper |
| Reconcile posting totals ↔ 835s ↔ bank deposits | Biller + bookkeeper |
| DSO invoices the management fee; PC pays it | Ops / finance |
| Review KPIs against target | Leadership |
| Resolve aged credit balances and issue refunds | Biller |
| Check the compliance calendar for the coming 60 days | Ops |
| Run scheduled LEIE, SAM.gov, and state-list checks for the populations and cadence in the compliance policy | Ops |
## Your first KPIs
Start with seven metrics. Early denominators will be small, so use the first months to establish a baseline and watch the trend.
### Clean claim rate
Claims accepted on first submission without rejection or denial, divided by total claims submitted.
**Illustrative target: 95%+.** A lower rate should prompt a root-cause review across enrollment data, eligibility, attachments, coding, and payer-specific edits.
### Days in AR
Total accounts receivable divided by average daily net production.
**Illustrative benchmark: under 40 days; under 30 is often considered strong.** Patient portions collected at the point of care can shorten the cycle, but payer mix and launch timing affect the result. Watch the trend during the first six months because a new practice's AR is distorted by the ramp.
### Denial rate
Claim lines denied divided by claim lines adjudicated; **after excluding downgrades, frequency-limit reductions, and exhausted annual maximums**, which are benefit design, not errors.
**Illustrative benchmark: under 5–10%.** A rate that mixes downgrades with true denials obscures the result. Break true denials down by CARC to identify the upstream process that needs review. See [Denial code playbook](/reference/edi/denial-code-playbook).
### Net collection rate
Payments received divided by (production minus contractual write-offs); what you collected out of what you were *entitled* to collect.
**Illustrative target: 95%+.** Review missed filing limits, unsupported write-offs, unworked patient balances, and incorrectly posted downgrades when the rate falls.
### Percentage of AR over 90 days
**Illustrative benchmark: under 15–20%.** Older balances generally have a lower probability of full collection, so review both the percentage and the causes of aging.
### PPO write-off percentage
Contractual adjustments divided by gross production. Participating PPO practices typically write off **30–45% of gross production**, and consultants flag sustained adjustment rates above roughly 40% as a signal to renegotiate or drop specific fee schedules.1
Track the percentage **by plan** as well as in aggregate. The comparison can identify a fee schedule that warrants contract review and is also useful in transaction diligence. See [DSO economics](/concepts/finance/dso-economics).
### Hygiene reappointment rate
The share of hygiene patients who leave with their next hygiene visit booked. Consultant sources cite **85–95%** for high-performing practices and report that only about half of practices pre-book at all.2
Hygiene recall can provide a steady base of visits and may account for a meaningful share of production. A weak reappointment rate also reduces later opportunities for preventive care and diagnosis, so track it alongside schedule capacity and patient retention.
Track claim metrics **by payer** and write-offs **by plan**. A blended rate can hide one payer or plan that needs attention.
## What you're not doing yet
Deliberately deferred past day 90 for most groups: a second location, an in-house membership plan, medical-crossover billing for sleep appliances and surgical work, fee-schedule renegotiation, and a second state. Build the rhythm first.
## The four tutorials in this section
Stand up the daily and weekly cadences with checklists.
Compare an alternate-benefit downgrade with a correctable claim denial.
A patient overpays. Detect, verify, refund, record.
Two entities, one reconciliation, no commingling.
Then set up the [compliance calendar](/start/first-90-days/compliance-calendar) for recurring filings, renewals, and reviews.
## Sources
1. Consultant benchmarks derived from the ADA 2023 Dental Fees Survey and practice-analytics datasets: Veritas Dental Resources, [The True Cost of Dental Insurance Participation](https://veritasdentalresources.com/post/the-true-cost-of-dental-insurance-participation-a-write-off-reality-check); benchmark thresholds: [Dental billing KPIs & benchmarks](https://dentalbillingassist.com/blog/posts/dental-billing-kpis-benchmarks).
2. Cast Hub, [Recall and hygiene retention benchmarks](https://cast-hub.com/dental-practice-revenue/recall-and-hygiene-retention/); recall-rate ranges: [DentX, Dental recall rate benchmarks](https://dentx.ca/blog/dental-recall-rate-benchmarks/). Consultant-sourced figures; directionally consistent across sources, not audited statistics.