The Problem: Dental’s Legacy Stack Is Breaking Down
Most dental payers still run on outdated platforms stitched together with manual processes. That’s not just inefficient — it’s expensive and unsustainable.
- 75–85% auto-adjudication rates mean 15–25% of claims still require human review.
- ~20% of claims are non-EDI (paper, email, fax) — causing delays and manual entry.
- 45–60 days to onboard providers, with credentialing done manually.
- >5 minute average call handle times, due to fragmented systems.
- ~18 months to launch a new plan, slowing go-to-market cycles.
- ~6 months from quote to contract for group plans, creating bottlenecks.
These inefficiencies inflate administrative spend, often exceeding 12.5% of premiums and limit the agility needed to grow in today’s market.
The LightSpun Advantage
LightSpun replaces these fragmented workflows with modern, modular automation that is purpose-built for dental. Our infrastructure streamlines claims, credentialing, call center ops, and sales workflows through AI-powered automation.
Here’s the impact:
| Industry | With LightSpun | |
|---|---|---|
| Premium | $30.00 average dental PMPM |
$30.00 |
| Claims Expenses | $21.00 targeting 70% loss ratio |
$21.00 |
| Total Retention | $9.00 | $9.00 |
| Commissions | $3.00 | $3.00 |
| Premium Tax | $0.75 | $0.75 |
| Administration | $3.75 12.5% of premium goes towards administration |
$1.50 5% of premium goes towards administration |
| Margin | $1.50 5% net margin |
$3.75 12.5% net margin |
Why Now?
Medical insurance has already embraced AI for claims processing, member service, and fraud detection. Dental is still behind — but it doesn’t have to be.
“Dental payers have a unique opportunity to leapfrog legacy challenges by adopting AI-driven infrastructure today — not tomorrow.”
— Rex Salisbury, LightSpun Investor
The time to modernize is now. Margins are tightening, members expect digital-first service, and the market is ripe for disruption.
Build the Future of Dental with LightSpun
LightSpun gives dental payers the tools to scale operations, serve members better, and reclaim margin — all through a flexible, API-first platform that plugs into your existing systems.
If you're ready to modernize dental insurance, let’s talk.
