Carelyze provides dental front desks with real‑time, patient‑ready cost estimates by reading treatment‑plan PDFs, logging into carrier portals, and applying live coverage rules without any EHR integration. The platform pulls eligibility, benefits, deductibles, and annual maximums directly from insurers, delivering line‑item estimates with traceable rule explanations and confidence scores, enabling staff to quote accurate out‑of‑pocket amounts at check‑in.
Funding
Funding not disclosed
Founders
Product
Problem
Dental front desks must manually extract procedure codes from treatment‑plan PDFs, log into multiple carrier portals, and calculate patient responsibility using complex plan rules, which is time‑consuming and error‑prone.
Solution
Carelyze automates this workflow by ingesting the PDF treatment plan, extracting CDT codes, teeth, and fees, and then logging into each patient’s carrier portal to pull live eligibility, benefits, deductibles, and annual maximums. The platform applies the carrier‑specific rules to generate a line‑item estimate that separates insurance coverage from patient out‑of‑pocket costs. Each estimate includes a traceable audit trail and confidence score, allowing staff to verify and explain the numbers at check‑in. The solution requires no integration with the practice’s EHR and works with any PDF export, delivering estimates overnight or on‑the‑fly when plan details change.
Target Audience
Primary users are dental practice front‑desk teams and administrators who need accurate, real‑time patient cost estimates at check‑in.
Features
- PDF ingestion with automatic CDT code, tooth, and fee extraction
- Secure login to carrier provider portals, handling MFA to retrieve live eligibility, benefits, deductible and annual max data
- Rule‑based pricing engine that applies contracted fees, carrier caps, deductibles, frequency limits, waiting periods, and secondary coverage in the correct order
- Line‑item, traceable estimates with per‑dollar source attribution and confidence scoring
- Real‑time re‑run capability at the chair for plan changes
- HIPAA‑aligned encryption, per‑clinic data isolation, and full audit logging
- Support for multiple carriers (Delta Dental live, Guardian and Anthem in rollout)