Dan Mathieson
Live Demos

Dental Eligibility Intelligence

A live demo of the hybrid-RAG eligibility verification engine built in production at Thoughtful AI. The system achieved 95%+ accuracy within two days on a live dental billing workflow.

🔒Exact matches bypass the LLM entirely·✦Novel cases go through GPT-4o with retrieved context·+Approved results expand the library automatically
18base cases
0session approved
Technical writeup →
Case Library18 base · 0 session
Base Library18 verified cases
D2140Delta Dental PPO
80% covered97%

Amalgam restorations: covered at 80% after deductible for basic restor…

D2740Cigna DPPO
50% covered71%

Major restorative services including crowns may be covered at 50% afte…

D1351MetLife PDP
Not covered96%

Dental sealants: covered at 100% for patients age 15 and under, perman…

D2391Aetna DMO
80% covered92%

Resin-based composites (posterior): covered at 80% after deductible as…

D2150Guardian PPO
Not covered94%

Amalgam restorations: covered at 80% after deductible. Frequency limit…

D7140Humana Dental HMO
Not covered31%

Basic dental services are generally covered subject to plan provisions…

D1110United Concordia Advantage
100% covered98%

Preventive services: covered at 100% with no deductible. Adult prophyl…

D0274Blue Cross Blue Shield Federal Employee Program
100% covered98%

Diagnostic X-rays: covered at 100% preventive benefit. Bitewing radiog…

D3330Cigna DPPO
50% covered88%

Endodontic services: covered at 50% after deductible as major restorat…

D4341Delta Dental Premier
80% covered89%

Periodontal treatment: covered at 80% after deductible as basic period…

D6010MetLife PDP
Not covered99%

Implants: not a covered benefit under this plan. Members seeking impla…

D5213Guardian PPO
50% covered91%

Major prosthodontic services: covered at 50% after deductible. Waiting…

D2331Aetna PPO
80% covered95%

Basic restorative: covered at 80% after deductible. Anterior composite…

D0150United Healthcare Dental
100% covered97%

Diagnostic services: covered at 100% preventive benefit, no deductible…

D1208Blue Cross Blue Shield of Illinois
Not covered97%

Preventive services: fluoride treatment covered at 100%, no deductible…

D2950Delta Dental PPO
50% covered88%

Core buildups (D2950): covered at 50% as major restorative when submit…

D9110Humana PPO
100% covered93%

Emergency dental treatment: D9110 covered at 100% preventive benefit w…

D8080Delta Dental PPO
Not covered98%

Orthodontic treatment: lifetime maximum $1,500 for eligible dependents…

Eligibility RequestEdit fields or select a case above
?
As you grow more confident in the AI's ability to determine eligibility and benefits, you can lower the auto-approval threshold to remove the human-in-the-loop component of the AI decision making. At 100%, only exact query matches bypass review. At lower values, near-identical cases also auto-approve.
50%: Trust AI broadly100%: Exact match only
Determination
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Enter procedure details and run an eligibility check.

The system searches the verified case library first. Novel cases are synthesized by GPT-4o and routed for human review.