Kentucky practices share the same structural exposure: five MCOs processing dental claims differently, expanded adult benefits increasing PA requirements, and an Anthem BCBS and Humana commercial market generating underpayment without active EOB reconciliation.
Kentucky's 2023 Expanded Benefit & New PA Triggers
Kentucky's Five Medicaid MCOs & Anthem's 2025 Departure
Passport by Molina: DentaQuest Replaced Avesis
Anthem BCBS and Humana Dominate the Commercial Market
TransDontics’s 1,100+ in-house dental billing specialists are supported by RPA automation engineered for Kentucky’s dental billing environment. Every process is designed around the actual payer rules, fee schedules, and documentation standards your claims will face.
Our RPA handles MCO eligibility verification, claim scrubbing, portal submissions, and status tracking across all five Kentucky MCOs while specialists handle prior auth follow-up, EOB reconciliation, documentation gaps, and commercial underpayment appeals.
Every payment is reconciled line by line. Kentucky's five MCO fee schedules; misalignments between DMS rates and MCO payments are a documented underpayment source, we flag every shortfall and appeal within 14 days, catching what passes through as technically paid but incorrectly calculated.
For every PA-required adult Medicaid claim, we confirm MCO enrollment, submit through the correct portal with required clinical documentation, and track approval before filing. Each of Kentucky's five MCOs carries different PA criteria; we apply current knowledge of all five on every submission.
Claims processed within 48 hours of receipt. No setup fee, no monthly minimum, no long-term contract, and no hidden costs. Our fee is a nominal percentage of what we successfully collect from payers on your behalf. We only earn when you get paid, which means our incentives align with your practice.
Expert CDT coding, clean claim submission, and aggressive denial management by specialty-certified billers. 98% first-pass clean claim rate.
No claim goes 48 hours without follow-up. We pursue every outstanding balance across all payers until it is paid, appealed or written off.
Get in-network faster. We handle all payer paperwork, CAQH maintenance, renewals, and compliance tracking so you start seeing insured patients.
Full revenue cycle coverage from patient registration to final payment. We manage all claims, close every gap, and maximize your collections.
Strategic oversight of your practice’s operational and financial performance. We track collections, payer mix, and productivity metrics
Complete front office billing support covering patient billing inquiries, insurance comms, prior auth, and appointment-linked verification.
HIPAA-compliant dental transcription delivered fast and accurately. Clinical notes, procedure documentation, and patient records are transcribed.
We review your last 12 months, find your top 3 revenue leaks, and show you exactly what we fix. Practices often discover recoverable revenue.
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An in-house biller knows your practice; not Kentucky’s five MCO PA criteria, post-2023 DentaQuest requirements, or Humana’s commercial versus Medicaid fee differences. Turnover resets that knowledge. Ours doesn’t.
Most billing companies submit claims. They won’t reconcile EOBs against five Kentucky MCO fee schedules, catch Anthem routing errors, manage DentaQuest PA for Passport members, or pursue MCO underpayments.
Most billing companies are a service. TransDontics is a system: RPA catching what humans miss at volume, experienced billers catching what automation cannot judge. The result is a first-pass acceptance rate of 98%.
Three steps. No disruption. No risk.
We connect directly to Dentrix, Eaglesoft, or your existing PMS. No migration, no new systems, no disruption.
Three steps. No disruption. No risk.
We review your claims, A/R, and denial patterns at zero cost. Most practices find 5–10% in hidden revenue leakage.
We connect directly to Dentrix, Eaglesoft, or your existing PMS. No migration, no new systems, no disruption.
We don’t publish named case studies because most clients prefer to keep billing performance private. What we can share is what the numbers look like across practices with comparable payer profiles.
Based on aggregated results across dental practices in comparable payer environments.
| Metric | Before TransDontics | After TransDontics |
|---|---|---|
| Average Denial Rate | 8–12% | Under 2.3% |
| First-Pass Clean Claim Rate | 70–80% | 98% |
| A/R Over 90 Days | 30–40% of Total AR | Reduced by 30%+ |
| Average A/R Resolution | 45+ Days | 18–25 Days |
| Claim Turnaround | 3–5 Days | 48 Hours |
| Revenue Growth (120 days) | Baseline | 5–12% Increase |
A Louisville general dentistry practice arrived with an 11% denial rate, 34% of A/R past 90 days, and a backlog of adult Medicaid claims denied post Avesis-to-DentaQuest transition. Hundreds in rejected claims sat completely unworked.
Each Kentucky MCO routes dental PA independently; Passport via DentaQuest, UHC on its own portal, Humana under two entirely different rule sets. National vendors treat them as one program. That’s the mistake.
All dental credentialing, claims, and PA requests route through DentaQuest since April 2023. Practices that didn’t update workflows at transition are still generating rejections. We manage Passport/DentaQuest.
Dental benefits governed by the January 2025 Kentucky Medicaid benefit grid. UHC processes its own prior authorization requests with a 12-month timely filing window. We track every claim from submission through final payment.
Expanded statewide footprint for 2024 with independent PA processing under 907 KAR 1:126, including MAP 9A orthodontic agreements. Transdontics manages WellCare dental claims under current benefit and prior authorization rules.
Independent PA processing through its own clinical criteria framework, separate from commercial Aetna operations. We manage all Aetna Better Health claims under current Kentucky Medicaid rules through resolution.
Louisville’s Humana concentration, Lexington’s constant plan turnover, Northern Kentucky’s cross-state COB issues, and Eastern Kentucky’s Medicaid-heavy Appalachian counties all bill differently. We already know how.
Every Kentucky practice qualifies. If your city isn’t listed, it’s coming. Reach out now and we’ll onboard your practice without delay.
Every state has its own payer rules, Medicaid structure, and billing landmines. TransDontics expertly navigates all of them.
Kentucky practices carry HIPAA, Kentucky Dental Practice Act, and Medicaid billing standards under 907 KAR 1:126. Under 201 KAR 8:540, records must be retained seven years from last treatment. TransDontics is independently HIPAA certified and SOC 2 Type II compliant.
All patient data is encrypted end-to-end, satisfying HIPAA Security Rule technical safeguards and Kentucky's patient records confidentiality requirements under KRS 422.317. Every data transmission meets the highest applicable standard, not just the minimum.
Only credentialed TransDontics personnel can access your practice data, eliminating the internal access vulnerabilities that turn in-house billing into a compliance liability most Kentucky practice owners do not realize they are carrying until it is too late.
Our AICPA SOC 2 Type II certification is independently audited and renewed annually. Everything is documented and third-party verified; providing demonstrable proof of our security posture. Your Kentucky practice's liability exposure is measurably reduced from day one of our partnership.
Customized billing solutions based on your specialty
In-house billing looks cheaper on paper. It rarely is. Between staffing overhead, turnover, training costs, and the revenue lost to unworked MCO denials, most practices are spending far more and collecting far less. TransDontics’s fee is a percentage of what you actually collect. That is the whole model.
Average Kentucky salary
*Salary benchmarks based on Kentucky BLS/Zip Recruiter data. Results vary by practice size and payer mix.
Our Complimentary audit covers denied claims, MCO routing errors, and underpayments, no obligation, no pitch.
Kentucky’s 2023 adult Medicaid expansion increased PA-triggered procedures across five MCOs with distinct criteria. Anthem’s 2025 MCO exit reshuffled member assignments requiring real-time routing updates. Humana operates as both commercial carrier and Medicaid MCO under fundamentally different billing rules.
RPA handles MCO eligibility, claim scrubbing, portal submissions, and payment posting. Specialists handle PA follow-up, EOB reconciliation, documentation gaps, and payer escalations. The combination sustains 96–98% first-pass rates. Either layer alone doesn’t produce that result.
Yes. Humana Healthy Horizons, Passport by Molina/DentaQuest, UnitedHealthcare Community Plan, WellCare, and Aetna Better Health are managed as distinct workflows. Each uses different portals, PA criteria, and fee schedules. Treating them as one workflow is the primary preventable denial source we find during audits.
Yes. Under 201 KAR 8:540, records must be retained seven years from last treatment. Under 907 KAR 1:026, Medicaid records must substantiate services and document medical necessity. Claims lacking required documentation cannot survive MCO audits or DMS reviews.
TransDontics charges a small percentage commission based solely on what your practice successfully collects from insurance payers. There are no upfront fees, no monthly retainers, and no hidden charges. If you do not collect, we do not earn. Our incentive is always directly aligned with your practice’s revenue performance.
All active Kentucky payers; five Medicaid MCOs, Anthem BCBS, Delta Dental, Humana commercial, Cigna, Aetna, UnitedHealthcare, MetLife, Guardian, GEHA, FEDVIP, TRICARE, and all other active national carriers.
Under 907 KAR 1:126, claims must be received within 12 months of service, 12 months from retroactive eligibility, or six months from Medicare adjudication for COB claims. Claims after the deadline are provider liability; the member cannot be billed.
No setup fee. No monthly minimum.
Cancel anytime.
Response within 24 hours.
HIPAA-compliant from day one.
Pay only a percentage of what we collect for you
