Dental Claim AI Agent Blueprint — Pre-Auth, EHB & COB for Ontario Clinics

Ontario dental clinics deal with one of the most complex insurance billing environments in healthcare — predeterminations for major restorative work, EHB claims across six or more insurers, coordination of benefits for dual-coverage patients, and a constant flow of denials.This DIY blueprint gives you three complete Make.com + Claude API automation modules. Set it up in your own Make.com account in under 2 hours. Your patient data stays with you. MODULE A — Pre-Authorization / PredeterminationCrowns, bridges, dentures, implants, orthodontics. AI drafts the complete clinical justification letter, lists required X-rays and documents, assigns ODA billing codes, and flags alternate benefit risk before you waste time on a package that will be modified. MODULE B — EHB Claim Tracking + Denial AppealsTrack every claim across Sun Life, Manulife, Canada Life, Blue Cross, Desjardins, and iA Financial. Auto-follow-up at Day 15. Denial appeal letters generated instantly for every denial reason — alternate benefit, frequency exceeded, missing tooth clause, plan maximum. MODULE C — Coordination of Benefits (COB) + Healthy Smiles OntarioCOB billing errors cost Ontario dental clinics thousands per year. AI calculates the correct primary/secondary billing sequence, generates the secondary claim checklist after primary EOB, and tracks Healthy Smiles Ontario provincial program eligibility and claims. WHAT'S INCLUDED:- All 3 complete Make.com workflow blueprints (copy and deploy)- 3 exact Claude API system prompts — Pre-Auth, EHB Appeal, COB Guide- Google Sheets 4-tab dashboard setup guide- 8-step automated workflow explained- Step-by-step setup guide (under 2 hours)- Phase 2 expansions: annual maximum alerts, ODA code suggester, denial pattern report- Done-For-You setup available at $497 TOTAL RUNNING COST: $14–$31 CAD/monthOne recovered crown predetermination ($800–$2,000) pays for an entire year of this system.Works for: general dentistry, orthodontics, oral surgery, pediatric dentistry, and multi-dentist group practices.NOTE: Your patient data stays in YOUR Google and Make.com accounts. artefac.digital does not store, process, or access your clinic's patient information.---TAGS:dental billing, pre-authorization, EHB claims, coordination of benefits, Ontario dentist, COB, Make.com, Claude API, AI automation, dental insurance Canada

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