Rhode Island runs Medicaid dental on two completely separate tracks, its MCO structure has been in active procurement transition, and the commercial market is small enough that repeated denials from a single payer can meaningfully move your monthly collections.
Rhode Island’s Split-Track Medicaid Dental System
RIte Smiles Prior Authorization Complexity
Commercial Payer Density in a Compact Market
HIPAA and R.I. Gen. Laws Chapter 5-37.3 Compliance
TransDontics’s 1,100+ in-house dental billing specialists are supported by RCM automation engineered for Rhode Island’s dental billing environment. Every process is designed around the actual payer rules, fee schedules, and documentation standards your claims will face.
TransDontics combines manual expertise with RCM automation. Automation handles eligibility, claim scrubbing, and payment posting while specialists handle RIte Smiles prior auth appeals, FFS Medicaid EOB reconciliation, and patient track determination before every claim.
Every payment is reconciled against your contracted rate, line by line, across every payer. When Delta Dental of Rhode Island, Blue Cross RI, or any commercial carrier pays below the agreed fee on specific plan types, we flag it and file the appeal within 14 days. Most practices only catch outright denials. We go further.
Before every Rhode Island Medicaid claim, we confirm adult FFS or RIte Smiles coverage, verify eligibility through RI Anchor, and format to the correct submission channel. Coverage changes; common in Rhode Island's Medicaid population are caught before they become denials.
Claims processed within 48 hours of receipt. No setup fee, no monthly minimum, no long-term contract, and no hidden costs buried in the fine print. Our fee is a nominal percentage of what we successfully collect from payers on your behalf. We only earn when you get paid.
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 RIte Smiles age-in transitions, FFS Medicaid timely filing windows, or Delta Dental RI’s Anchor Dental versus individual PPO fee schedule differences. Turnover resets that knowledge.
Most billing companies submit claims. They won’t distinguish FFS Medicaid Gainwell submissions from RIte Smiles UnitedHealthcare Dental portal routing, flag BCBSRI underpayments, or chase uncollected Medicaid revenue.
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 Providence practice came to us routing RIte Smiles pediatric claims to Gainwell Technologies instead of UnitedHealthcare Dental’s portal with 11%+ denial rate, 35% of A/R past 90 days, and three hours daily of inconsistent follow-up calls.
Our specialists know every Rhode Island payer’s rules and appeal processes. Generalist billing companies confuse FFS Medicaid with RIte Smiles routing, miss BCBSRI plan nuances, and overlook Delta Dental RI underpayments. We don’t.
Rhode Island’s largest commercial dental carrier, administering Anchor Dental state employee plans across three tiers with full fee schedule compliance and EOB reconciliation.
TransDontics handles Rhode Island claims daily, knowing Delta Dental RI’s Anchor Dental versus commercial PPO fee differences, RIte Smiles prior auth CDT code updates, and BCBSRI’s distinct commercial versus group plan submission protocols.
Every Rhode Island 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.
Rhode Island practices carry HIPAA obligations alongside R.I. Gen. Laws Chapter 5-37.3 and 216-RICR-40-05-2 electronic records requirements. TransDontics is independently certified under both frameworks statewide.
All patient data is encrypted end-to-end, satisfying the HIPAA Security Rule and the electronic health information protections applicable to Rhode Island dental providers under Chapter 5-37.3. Every transmission meets the highest applicable standard; not just the minimum required by federal law.
Only credentialed TransDontics personnel can access your practice data, eliminating the internal access vulnerabilities that turn in-house billing into a compliance liability most Rhode Island practice owners don’t realize they’re carrying until it is too late.
Our AICPA SOC 2 Type II certification is independently audited and renewed annually. Everything is documented, third-party verified proof of our security posture. Your Rhode Island practice’s liability exposure is measurably reduced from day one of our partnership.
Customized billing solutions based on your specialty
Average RI salary (medical biller)
*Salary benchmarks based on Rhode Island BLS/ZipRecruiter data. Results vary by practice size and payer mix.
Our Complimentary audit covers denied claims, MCO routing errors, and underpayments, no obligation, no pitch.
RPA handles volume tasks automatically and continuously, eligibility checks, claim scrubbing, Medicaid track routing, status tracking, payment posting. Billing specialists handle what requires judgment: RIte Smiles prior authorization appeals, FFS Medicaid timely filing exception documentation, EOB reconciliation, payer escalations. The combination is what keeps the first-pass rate at 98%. Either layer alone doesn’t get there.
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
