AI Care Quality — Dental Network Intelligence for Carriers
Dental Network Intelligence · Carrier Edition

Your dental network is leaking money.
We show you where.

AICQ is the dental-specific intelligence platform that gives carriers total visibility into their provider network. We don't just audit claims — we fingerprint how providers actually practice, and turn that intelligence into recovery, smarter networks, and better care.

FWA Detection Doctor Scorecards Network Steerage Fee Optimization VBC Framework
Built for Carriers · TPAs · Self-Insured Employers · HIPAA-aligned · SOC 2-ready
$12–15B
Lost to dental fraud, waste & abuse every year in the US
5–10%
Of your dental claims spend is estimated waste
95%
Of that waste goes completely undetected today
3–6×
First-year ROI typically delivered with AICQ
FWA Exposure Calculator

How much is hiding in your network?

Move the sliders to model your exposure. The default 5% waste rate is conservative — ADA, CMS, and industry studies put dental FWA at 3–10% of claims spend, with up to 95% going undetected by rules-based systems.

Covered lives 2.0M
100K — 25M members
Average dental PMPM $30
Typical group dental PMPM range: $25 — $45
Estimated waste rate 5.0%
ADA / industry-referenced range: 3% (low) — 10% (high). Default 5% is conservative.

2,000,000 lives × $30 PMPM × 12 months = $720M annual claims

Your annual claims spend
$720M
Potential waste exposure
$36M
Hiding in your network — before fee optimization, steerage, or quality gains compound the impact.

Directional estimate for executive conversation. AICQ delivers a carrier-specific ROI model on actual claims data during diligence — not a generic spreadsheet.

Doctor Scorecards · Model Dentist

Every provider, scored and tiered.

We score every dentist in your network across the dimensions that actually predict cost and outcomes — then tier them 1–5 so your team can reward the best, manage the rest. Defensible, evidence-based, and explainable to credentialing.

What we measure

Four pillars, calibrated to your network's actual practice patterns and benchmarked against ADA, CDC, USPSTF, and PubMed standards.

Preventive Focus

Recall adherence, fluoride utilization, sealants, exam cadence.

Treatment Quality

Restoration durability, retreatment rates, complications, appeals.

Cost Appropriateness

Procedure mix vs. peers, fee positioning, value-aligned care.

Patient Continuity

Member retention, treatment plan completion, coordination.

Quality scores update continuously. See providers improving — or degrading — before it becomes a network problem.

Sample tier distribution

T1 Top performersReward · steer to · contract
T2 StrongSteer to · maintain
T3 AverageMonitor · coach
T4 Below standardCoach · improve · audit
T5 OutliersInvestigate · remediate · remove

Tiering supports targeted fee adjustments, P4P incentives, and value-based contracting — not just pass/fail decisions.

The Edge · Nobody Else Does This

Behavioral fingerprinting. One profile, two outputs.

Most platforms inspect claims one at a time. We profile how each provider actually practices across dozens of behavioral signals simultaneously — then run two engines off the same fingerprint: a quality score and an FWA risk score. That shared substrate is why we catch what rules-based systems miss.

Inputs
Behavioral signals
Procedure mix, sequencing, dose, cadence, peer deltas, longitudinal patterns
Provider Fingerprint
One profile
Every provider, continuously updated
Outputs
Quality score · FWA risk
Defensible tiering, dollar-impact ranking, audit-ready evidence
The Full Platform

One platform. Every lever.

Six capabilities, one unified dashboard, one provider profile. The AI assistant lets your team query the entire network in plain English — no SQL, no reports queue.

01

Recover Hidden Waste

Catch what rules-based systems miss.

Behavioral models surface upcoding, unbundling, phantom billing, and overtreatment that static rules will never find.

02

Steer Your Network

Direct members to better care.

Every provider scored and tiered using your specific claims data. Reward the best. Manage the rest.

03

Fee Optimization

Negotiate from data, not gut.

Regional fee benchmarking and network fee indexing. Know exactly where you're overpaying versus market.

04

Measure Quality of Care

Objective provider performance.

Track retreatment rates, complications, restoration durability, and preventive coverage across your full book.

05

Power Value-Based Care

Tiered networks, P4P, VBC contracts.

Objective scorecards build tiered networks, P4P incentives, and value-based contracts — the data foundation carriers need.

06

Supercharge Your SIU

Prioritized by dollar impact.

Investigators get a heat map ranked by estimated dollar impact — not a phone book of unsorted tips.

Why We're Different

The dental FWA market is dominated by medical-first tools and rules engines.

We took a fundamentally different approach — and that's exactly why we catch what they miss.

✗ The Industry Standard

  • Reactive. Wait for a claim to fail a rule, then investigate.
  • Rules-based. Static flags that providers learn to game.
  • Medical-first. Dental is a bolt-on module — not the focus.
  • Claim-level. One claim at a time. Misses the pattern.
  • Catches 3–5%. The other 95% flows through undetected.

✓ The AICQ Approach

  • Proactive. Identify waste patterns before they compound.
  • Behavioral AI. Models that learn and adapt — can't be gamed.
  • Dental-only. Built day one for CDT codes and dental practice patterns.
  • Provider-level. We fingerprint entire practice patterns — not claims.
  • Finds the other 95%. Patterns no claim audit will ever surface.
How It Works

From data to action in 60 to 90 days.

No IT project. No multi-year implementation. If you can export claims data today, you can be live with AICQ. We build the ingestion pipeline on our side, map to your formats, and handle every transformation.

01

Connect your claims data

837D / 835 EDI · SFTP · API · standard flat files. Your team sends files — we handle the rest.

02

Fingerprint every provider

Every dentist profiled across dozens of behavioral signals simultaneously.

03

Score & tier the network

Tier 1–5 quality scoring plus FWA risk ranking with dollar exposure.

04

Act on validated insights

Steerage, fee strategy, SIU case files, value-based contract design.

60–90 days to first actionable insights · Pilots on a defined subset of your book are standard · Most carriers move to full deployment within 6 months once they see the dollars. Start the conversation
Built By Operators

40+ years inside dental carriers, technology, and the data.

We built AICQ because we saw what was missing. Proven operators across the carrier, technology, and operations sides of dental — building the platform we wished existed.

MC

Michael Cembrola

CEO & Co-Founder
  • 22+ yrs leading growth across large dental & medical payers
  • Former National Sales Leader at Delta Dental — drove $780M in new revenue, managed $1.7B in existing business
  • Former CRO, Onsite Dental — largest U.S. mobile dentistry provider
CI

Craig Iott

COO & Co-Founder
  • 10+ years in operations and strategy consulting, dental industry focus
  • Founder of All Solutions Consulting — fractional partner to dental technology companies on operations, GTM, and scalable execution
  • Operator-first lens on product launch, growth, and value chain integration across the dental ecosystem
JP

Jonathan Palma

CTO & Co-Founder
  • 9+ years leading engineering teams shipping high-impact software
  • Founder of the first AI-native PMS in Latin America
  • Multi-tenant SaaS, RBAC, HIPAA-baked-in; previously team lead for Disney and ESPN
Real Objections · Real Answers

Questions we hear.

"We already have an FWA solution."

Great — we catch the 95% it misses. We're a force multiplier, not a replacement. Run a side-by-side and let the dollars decide.

"Is dental FWA really big enough to matter?"

At $30 PMPM, even 5% waste on your book is material. Let us run the math on your numbers — your CFO will be interested.

"Your company is new — why trust you?"

New company, proven operators with 50+ years across carriers, DSOs, and clinical practice. Shared-savings model — we only get paid when you do.

"How long until we see results?"

60–90 days to first actionable insights. No multi-year implementation. No IT project. No timeline risk. Value, fast.

"What about HIPAA & data security?"

Full HIPAA compliance — BAA, AES-256 encryption, US-only infrastructure. Built to the standards your largest carrier partners already require.

"Can we start with a pilot?"

Yes — pilots on a defined subset of your book are standard. Most carriers move to full deployment within six months once they see the dollars.

Get Started

Ready to see what's hiding in your network?

Three steps to clarity on your exposure — and your savings opportunity.

130-min demo 2Carrier-specific ROI model 3Scoped pilot on your data

Prefer email? [email protected]