How ClariFi Validates Dental Claims in Real Time

The virtual card is the first checkpoint

Every ClariFi member gets a virtual payment card, loaded into Apple Pay or Google Pay, that's restricted to dental merchant category codes. That means the card simply won't authorize a transaction at a merchant that isn't coded as a dental provider, no manual review required for the vast majority of purchase attempts outside a dentist's office.

Procedure codes tie the payment to the plan

A restricted merchant category confirms the money went to a dentist. It doesn't confirm which procedures were performed, which is what determines how the employer's reimbursement schedule applies. That's where ADA procedure codes come in:

• 1

  The employee uploads a photo of their receipt in the ClariFi app after their visit.

• 2

  ClariFi reads the procedure codes on the receipt and matches them against the employer's plan rules.

• 3

  Any employee cost-share is calculated automatically and charged to the employee's personal card, while the employer-funded portion reconciles against the plan.

AI-based monitoring catches what rules alone would miss

Beyond code-by-code validation, ClariFi monitors billing patterns for anomalies, for example a merchant whose procedure mix looks inconsistent with a dental practice, or unusual spend velocity on a single card. If something looks off, the card can be frozen instantly while the transaction is reviewed, rather than discovered weeks later during a claims audit.

Why this replaces a network instead of needing one

Traditional insurance networks exist partly to negotiate rates and partly to control which providers can bill the plan at all. Real-time validation solves the second problem differently: any licensed dentist can be paid, because the validation happens on the transaction and the procedure codes, not on whether the provider signed a network contract in advance.