Verifidental — Implementation Playbook (DSO)

Verifidental Implementation Playbook for DSOs

Revenue Cycle AI: Automated Insurance Verification & Benefits Intelligence

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1. Executive Summary

What Verifidental Does

Verifidental is an AI-powered insurance verification and eligibility platform that automates real-time benefits retrieval, interprets complex payer responses into actionable coverage breakdowns, and integrates directly with practice management systems to eliminate manual verification workflows. The platform uses intelligent document parsing and payer database connections to deliver accurate patient coverage information in seconds rather than hours.

Why DSOs Specifically Benefit from Revenue Cycle AI

DSOs operating at scale face exponential complexity in revenue cycle management—each additional location multiplies the administrative burden of insurance verification across hundreds of payer contracts, thousands of patients, and dozens of staff members performing redundant manual tasks. Revenue cycle AI delivers three distinct advantages for multi-location organizations:

1. Scale Economies: Centralized AI processing eliminates the need for proportional staffing increases as location count grows. A 30-location DSO can achieve the verification throughput of a 60-person administrative team with a fraction of the headcount.

2. Standardization: AI enforces consistent verification protocols across all locations, eliminating the variance that occurs when individual staff interpret benefits differently. This standardization directly reduces claim denials caused by eligibility errors.

3. Data Aggregation Intelligence: Cross-location data enables pattern recognition impossible at the single-practice level—identifying payer-specific denial trends, benchmarking verification efficiency across regions, and predicting coverage issues before they become write-offs.

Expected Timeline: Decision to Full Deployment

Phase	Timeline	Milestone
Pre-Implementation	Weeks 1–2	Technical assessment complete, contracts signed
Pilot Wave (2–3 locations)	Weeks 3–5	Wave 1 go-live and stabilization
Wave 2 Expansion (5–8 locations)	Weeks 6–9	Scaled deployment validated
Wave 3+ (remaining locations)	Weeks 10–16	Full deployment complete
Optimization	Weeks 17–20	ROI validation and workflow refinement

Total timeline for 15–50 location DSO: 16–20 weeks from signed contract to full deployment

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2. Pre-Implementation Checklist (Weeks 1–2)

Technical Requirements

Hardware

☐ Workstations with minimum 8GB RAM, modern browser (Chrome 90+, Edge 90+, Firefox 88+) ☐ Dual monitors recommended for verification staff (side-by-side workflow) ☐ Stable internet connection: minimum 25 Mbps down / 10 Mbps up per location ☐ Scanner/document feeder for physical insurance card capture (if not already present)

Software

☐ Practice Management System compatibility verified:

• Dentrix G7.4+
• Eaglesoft 21.0+
• Open Dental 22.1+
• Curve Dental (cloud-native)
• Denticon (DSO edition) ☐ Operating system: Windows 10/11 or macOS 12+ for workstations ☐ PDF reader installed for coverage summary exports

Network

☐ Firewall allowlisting for Verifidental API endpoints (IP ranges provided by vendor) ☐ SSL/TLS 1.2+ enabled ☐ Outbound HTTPS (port 443) unrestricted ☐ Proxy configuration documented if applicable

🔵 Vendor Onboarding Steps

Step	Timeline	Owner	Deliverable
🔵 Kickoff call scheduling	Day 1	Verifidental CSM	Meeting invite with agenda
🔵 Enterprise agreement execution	Days 1–3	Legal/Verifidental	Signed MSA and BAA
🔵 Technical discovery call	Days 3–5	IT Lead/Verifidental	Integration requirements doc
🔵 Dedicated CSM assignment	Day 5	Verifidental	Named contact with SLAs
🔵 API credentials provisioning	Days 5–7	Verifidental	API keys, sandbox access
🔵 Training environment setup	Days 7–10	Verifidental	Demo tenant with test data

Key Vendor Contacts to Establish

☐ Customer Success Manager (primary relationship owner) ☐ Technical Integration Specialist (API/PMS integration support) ☐ Support escalation path (Tier 1 → Tier 2 → Engineering) ☐ Executive sponsor on vendor side (for escalation above CSM)

Data/Access Prerequisites

System Access Required

☐ PMS admin credentials for integration configuration ☐ API keys from PMS vendor (if using API integration vs. direct database) ☐ 🔵 Verifidental admin console access provisioned ☐ Payer portal credentials for direct eligibility queries (for payers not in Verifidental's clearinghouse network)

Data Preparation

☐ Patient demographic data export capability confirmed ☐ Active patient count by location documented ☐ Insurance plan inventory: list of top 20 payers by claim volume ☐ Historical verification data export (last 12 months) for baseline analysis

Internal Stakeholder Alignment

🟣 Approval Required From

☐ CEO/COO: Budget approval and strategic alignment sign-off ☐ CFO: ROI expectations and financial modeling approval ☐ Chief Dental Officer: Clinical workflow impact review ☐ IT Director: Security review and infrastructure approval ☐ VP of Operations: Rollout timeline and resource allocation ☐ Legal/Compliance: BAA and data handling review

Informed Stakeholders (No Approval Needed)

☐ Regional Managers: Rollout timeline and location expectations ☐ Office Managers: Preliminary communication about upcoming change ☐ Revenue Cycle Team Lead: Process redesign preview ☐ HR: Training time requirements and potential staffing impact

Stakeholder Alignment Map

┌─────────────────────────────────────────────────────────────────┐
│                    BOARD / INVESTORS                            │
│  Communication: Quarterly updates on AI ROI and efficiency gains│
│  Decision Rights: Budget approval >$100K, strategic initiatives │
└─────────────────────────────────────────────────────────────────┘
                              │
                              ▼
┌─────────────────────────────────────────────────────────────────┐
│                       C-SUITE                                   │
│  CEO: Strategic sponsor      CFO: ROI accountability            │
│  COO: Operational ownership  CDO: Clinical workflow sign-off    │
│  Communication: Weekly during rollout, monthly post-deployment  │
│  Decision Rights: Wave advancement, rollback decisions          │
└─────────────────────────────────────────────────────────────────┘
                              │
                              ▼
┌─────────────────────────────────────────────────────────────────┐
│                   REGIONAL MANAGERS                             │
│  Responsibility: Wave coordination, location readiness          │
│  Communication: Bi-weekly during rollout                        │
│  Decision Rights: Local scheduling, champion selection          │
└─────────────────────────────────────────────────────────────────┘
                              │
                              ▼
┌─────────────────────────────────────────────────────────────────┐
│                   OFFICE MANAGERS                               │
│  Responsibility: Day-to-day rollout execution                   │
│  Communication: Daily during go-live week                       │
│  Decision Rights: Staff scheduling for training                 │
└─────────────────────────────────────────────────────────────────┘
                              │
                              ▼
┌─────────────────────────────────────────────────────────────────┐
│                      PROVIDERS                                  │
│  Responsibility: Workflow adoption, patient communication       │
│  Communication: Training + weekly check-ins during transition   │
│  Decision Rights: None (training mandatory)                     │
└─────────────────────────────────────────────────────────────────┘

Baseline Metrics Capture

⚠️ Critical: Capture ALL metrics BEFORE go-live to enable ROI measurement

Metric	Measurement Method	Standard Definition
Verification Time per Patient	Time study (sample 50 patients/location over 1 week)	Start: staff opens patient record. End: verification complete and documented
Verification Completion Rate	PMS report: % of scheduled patients with verified benefits at appointment time	Verified = active coverage with breakdown documented
Claim Denial Rate (Eligibility-Related)	Clearinghouse report: denial codes 1, 2, 15, 16, 27, 29	Rolling 90-day average
Front Desk FTE Hours on Verification	Manager estimate + time study validation	Include phone hold time, portal navigation, documentation
Patient Wait Time at Check-In	Secret shopper or front desk log	Time from patient arrival to operatory seating
Write-Off Rate (Coverage Estimation Errors)	Accounting report: adjustments coded to "insurance estimate variance"	Rolling 90-day average as % of production
Days in A/R (Insurance)	PMS aging report	Average days from claim submission to payment

Standardizing Baseline Measurement Across Locations

☐ Create standardized data collection template with exact definitions ☐ Assign baseline collection owner at each pilot location ☐ ⚠️ Collect baselines during "normal" operating period (avoid holiday weeks, staff transitions) ☐ Require 2-week minimum data collection for statistical validity ☐ Central team validates methodology before accepting baseline data ☐ Document any location-specific anomalies (e.g., recently opened, payer mix unusual)

Enterprise-Level Requirements

Network Standards

☐ Document network architecture: centralized hub vs. location-autonomous ☐ Confirm VPN requirements for remote access to Verifidental ☐ Establish minimum bandwidth standards for all locations ☐ 🟣 Decide: centralized hosting (data flows to HQ) vs. location-level processing

Authentication & Security

☐ SSO integration requirements (SAML 2.0, OAuth 2.0) ☐ Active Directory or identity provider documentation ☐ MFA policy alignment with Verifidental capabilities ☐ Role-based access control matrix drafted

Centralized Credentialing

☐ Master payer credential repository established ☐ Credential sharing policy across locations defined ☐ 🔵 Verifidental's credential management approach confirmed ☐ Process for credential rotation documented

Estimated Time: 40–60 hours total across all stakeholders

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3. Location Readiness Assessment

Scoring Framework

Rate each location on the following factors using a 1–5 scale. Total possible score: 25 points.

Factor 1: IT Infrastructure Maturity (1–5)

Score	Criteria
5	Network speed >100 Mbps, all hardware <2 years old, PMS on latest version
4	Network speed >50 Mbps, hardware <3 years old, PMS within 1 version of current
3	Network speed 25–50 Mbps, hardware <4 years old, PMS supported but not current
2	Network speed 10–25 Mbps, hardware 4–5 years old, PMS version requires upgrade
1	Network speed <10 Mbps, hardware >5 years old, PMS version unsupported

Factor 2: Staff Tenure & Adaptability (1–5)

Score	Criteria
5	Avg tenure >3 years, <10% annual turnover, documented success with prior tech rollouts
4	Avg tenure 2–3 years, 10–20% turnover, positive reception to recent changes
3	Avg tenure 1–2 years, 20–30% turnover, mixed tech adoption history
2	Avg tenure 6mo–1 year, 30–40% turnover, resistance to recent changes
1	Avg tenure <6 months, >40% turnover, or recent significant staff upheaval

Factor 3: Patient Volume (1–5)

Score	Criteria	Impact Consideration
5	>100 patients/day	Highest ROI potential, but requires robust go-live support
4	75–100 patients/day	Strong ROI, manageable complexity
3	50–75 patients/day	Moderate impact, good pilot candidate
2	25–50 patients/day	Lower immediate impact, lower risk
1	<25 patients/day	Minimal volume for meaningful validation

Factor 4: Tech Stack Compatibility (1–5)

Score	Criteria
5	PMS has native Verifidental integration, digital imaging, modern workflow tools
4	PMS supported with standard API integration, compatible imaging
3	PMS supported but requires middleware or manual data sync
2	PMS supported with workarounds, some workflow manual steps required
1	PMS integration experimental or unavailable, requires custom development

Factor 5: Local Champion Availability (1–5)

Score	Criteria
5	Tech-forward Office Manager or provider, volunteer for pilot, prior champion experience
4	Engaged Office Manager willing to lead, no prior experience but high enthusiasm
3	Office Manager capable but not enthusiastic, requires regional support
2	No clear champion, will require significant central team involvement
1	Leadership turnover imminent or recent, no stable candidate available

Readiness Scoring Worksheet

Location	IT Infra (1-5)	Staff (1-5)	Volume (1-5)	Tech Stack (1-5)	Champion (1-5)	Total (5-25)
Location A
Location B
Location C
(continue)

Interpreting Scores and Recommended Rollout Sequence

Wave Assignment Matrix

Score Range	Readiness Tier	Wave Assignment	Rationale
21–25	High Readiness	Wave 1 (Pilot)	Low risk, high success probability, generates proof points
17–20	Moderate-High	Wave 2	Ready but may need minor preparation
13–16	Moderate	Wave 3	Address gaps during earlier waves
9–12	Moderate-Low	Wave 4+	Requires remediation before deployment
5–8	Low Readiness	Hold	Significant investment required; may defer

Wave 1 Selection Criteria (Choose 2–3 Locations)

Select locations that score 21–25 AND meet the following additional criteria:

☐ Representative Mix: Include at least one high-volume and one moderate-volume location ☐ Geographic Diversity: If multi-region, select from different regions to validate regional support model ☐ Payer Diversity: Ensure pilot locations collectively cover your top 10 payers by volume ☐ Champion Confidence: Local champion has direct line to regional manager and is comfortable escalating ☐ Avoid Outliers: Don't select locations with unusual characteristics that won't generalize (e.g., 100% Medicaid, specialty-only)

Pre-Rollout Remediation for Lower-Scoring Locations

Issue	Remediation	Timeline
IT Infrastructure <3	Network upgrade, hardware refresh	2–4 weeks
Staff Tenure <3	Delay until team stabilizes, or provide extra central support	Variable
Tech Stack <3	🔵 Engage Verifidental for integration assessment	1–2 weeks
Champion <3	Regional manager assigns interim champion, provides extra support	1 week

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4. Rollout Strategy

Recommended Wave Structure

Wave Overview

Wave	Locations	Duration	Objectives
Wave 1 (Pilot)	2–3 locations	3 weeks	Validate integration, train champions, establish benchmarks
Wave 2	5–8 locations	3 weeks	Scale training model, stress-test support capacity
Wave 3	8–15 locations	4 weeks	Full-scale deployment, regional ownership
Wave 4+	Remaining locations	2–4 weeks per wave	Complete deployment, address remediation cases

Buffer Between Waves

☐ Minimum 5 business days between waves for:

• Champion debrief and lessons learned documentation
• Training material updates based on feedback
• Support team capacity reset
• Go/no-go assessment completion

Selection Criteria for Wave 1 Pilot Locations

Required Criteria (All Must Be Met)

☐ Readiness score ≥21 ☐ Office Manager tenure >1 year ☐ No PMS migration planned in next 6 months ☐ No major staffing changes in last 90 days ☐ Regional Manager available for weekly check-ins

Preferred Criteria (Aim for 3+)

☐ Prior successful technology rollout ☐ Above-average claim denial rate (more room for improvement) ☐ Provider(s) vocally supportive of efficiency improvements ☐ Geographic proximity to central team or regional hub ☐ Patient volume in 50–75/day range (meaningful but manageable)

Detailed Timeline Per Wave

Wave 1: Pilot (Weeks 3–5)

Week	Activities
Week 3, Days 1–2	🔵 Integration go-live, champion training (on-site)
Week 3, Days 3–5	Parallel run: verify side-by-side with existing process
Week 4	Full transition, daily check-ins, troubleshooting
Week 5	Stabilization, metric collection, champion debrief

Wave 2: Expansion (Weeks 6–9)

Week	Activities
Week 6	Wave 1 lessons incorporated, Wave 2 champions trained (virtual with Wave 1 champions)
Weeks 7–8	Wave 2 go-live, staggered (2–3 locations every 2 days)
Week 9	Stabilization, metric comparison across locations

Wave 3+: Scale (Weeks 10+)

Week	Activities
Ongoing	Regional managers own wave execution
	Central team provides support escalation only
	4–5 locations go live per week maximum
	Weekly cross-location metric reviews

🟣 Go/No-Go Criteria to Advance Waves

Quantitative Gates (Must Pass All)

Metric	Wave 1→2 Threshold	Wave 2→3 Threshold
System uptime	≥99% during pilot	≥99.5%
Verification accuracy	≥95% match to manual verification	≥97%
Staff training completion	100% of pilot staff	100% of Wave 2 staff
Critical issues open	0 P1 issues	0 P1, <3 P2 issues
Champion confidence (survey)	≥4/5 average	≥4/5 average

Qualitative Gates

☐ No unresolved integration failures ☐ Support response times meeting SLA ☐ No provider refusals to use system ☐ 🔵 Vendor confirms readiness for next wave

🟣 Go/No-Go Decision Authority

Decision	Authority
Advance wave on schedule	VP of Operations
Delay wave 1–2 weeks	VP of Operations + IT Director
Delay wave >2 weeks	COO approval required
Cancel/restart wave	C-suite consensus

Rollback Plan

⚠️ When to Trigger Rollback

☐ System downtime >4 hours during business hours ☐ Verification accuracy <90% for 48+ hours ☐ Data integrity issue discovered (incorrect patient matching) ☐ 🔵 Vendor declares critical bug requiring extended fix

Rollback Execution Steps

1. Immediate (within 1 hour)

   • Central team notifies all affected locations
   • Locations revert to manual verification process
   • 🔵 Vendor engaged with P1 escalation

2. Short-term (within 24 hours)

   • Regional managers confirm all locations operating normally
   • Document incident timeline and root cause
   • Patient impact assessment completed

3. Recovery Planning

   • 🔵 Vendor provides fix timeline and validation plan
   • Central team determines go-live 2.0 date
   • Additional testing requirements defined

Rollback Isolation

☐ Rollback is location-specific — one location's rollback does not affect others ☐ Wave pause triggered only if >50% of wave locations require rollback ☐ Earlier waves continue operating during rollback

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5. Configuration & Integration (Weeks 2–3)

Step-by-Step PMS Integration

🔵 Dentrix Integration

Step	Action	Owner	Time Est.
1	🔵 Verifidental provides Dentrix integration package	Vendor	Day 1
2	Install Verifidental Connector on Dentrix server	Local IT	30 min
3	Configure database connection (read access to patient/insurance tables)	Local IT + Vendor	1 hour
4	Enable HL7/API bridge for real-time data sync	Local IT	30 min
5	🔵 Vendor validates connection and data flow	Vendor	1 hour
6	Configure auto-launch from Dentrix patient view	Local IT	15 min
7	Test with 10 sample patients, verify data accuracy	Champion	1 hour

⚠️ Common Failure Point: Dentrix database permissions often require Dentrix support involvement. Engage them proactively.

🔵 Eaglesoft Integration

Step	Action	Owner	Time Est.
1	🔵 Verifidental provides Eaglesoft integration credentials	Vendor	Day 1
2	Enable Eaglesoft's API access (may require Patterson support)	Local IT	1–2 hours
3	Install Verifidental bridge application	Local IT	30 min
4	Map Eaglesoft insurance codes to Verifidental payer IDs	Champion + Vendor	2 hours
5	🔵 Vendor validates bidirectional sync	Vendor	1 hour
6	Configure workflow triggers (appointment scheduled, patient check-in)	Champion	30 min
7	Test verification workflow with 10 patients	Champion	1 hour

⚠️ Common Failure Point: Eaglesoft API licensing may require upgrade. Confirm license level before integration begins.

🔵 Open Dental Integration

Step	Action	Owner	Time Est.
1	Verify Open Dental API access enabled (Setup → Advanced Settings)	Local IT	15 min
2	Generate API key for Verifidental	Local IT	10 min
3	🔵 Provide API key to Verifidental for tenant configuration	Vendor	10 min
4	🔵 Verifidental enables direct database query access	Vendor	30 min
5	Test bidirectional data flow	Champion + Vendor	1 hour
6	Configure automatic eligibility write-back to Open Dental	Champion	30 min
7	Verify insurance plan updates populate correctly	Champion	30 min

Note: Open Dental's open architecture typically makes this the smoothest integration path.

Clearinghouse & Payer Connection Setup

Step	Action	Owner	Time Est.
1	🔵 Provide Verifidental with list of top 20 payers by volume	Champion	30 min
2	🔵 Verifidental maps payers to clearinghouse connections	Vendor	2–3 days
3	For payers not in clearinghouse network, provide portal credentials	RCM Team	1–2 hours
4	🔵 Verifidental enables real-time eligibility for all mapped payers	Vendor	1–2 days
5	Test verification for each of top 20 payers	Champion	2–3 hours
6	Document any payers requiring manual verification fallback	Champion	30 min

Test Environment Setup

Centralized Test Environment (Recommended for DSOs)

☐ 🔵 Request dedicated sandbox tenant from Verifidental ☐ Populate sandbox with de-identified patient data (500–1000 records) ☐ Configure sandbox with representative payer mix ☐ Establish test scripts covering all common scenarios ☐ Assign test environment access to all champions

Validation Checklist

☐ Patient demographic pull: Verify name, DOB, address, SSN match PMS ☐ Insurance plan identification: Confirm payer, group, member ID correct ☐ Coverage breakdown: Verify deductible, maximums, waiting periods ☐ Frequency limitations: Confirm procedure-specific limits accurate ☐ Write-back: Confirm eligibility data returns to PMS correctly ☐ Error handling: Test behavior when payer unavailable or patient not found ☐ Performance: Verification completes in <15 seconds for 95%+ of queries

Data Migration / Historical Ingestion

⚠️ Decision Required: Determine whether to import historical verification data

If Importing Historical Data:

Step	Action	Owner	Time Est.
1	Export last 12 months of verification records from PMS	Local IT	2–4 hours
2	🔵 Provide export to Verifidental in required format	Champion	30 min
3	🔵 Verifidental ingests historical data	Vendor	1–2 days
4	Validate historical record count matches	Champion	1 hour
5	Spot-check 20 random records for accuracy	Champion	2 hours

If Not Importing (Fresh Start):

☐ Document decision and rationale ☐ Establish process for handling patients with recent verifications in legacy system ☐ Set expectation that AI learning curves may be steeper without historical data

Security & HIPAA Compliance Verification

Enterprise-Level HIPAA Checklist

Requirement	Verification Method	Owner	Status
BAA Executed	Signed agreement on file	Legal	☐
Data Encryption at Rest	🔵 Vendor SOC 2 report review	IT Security	☐
Data Encryption in Transit	TLS 1.2+ confirmed	IT Security	☐
Access Controls	Role-based access matrix documented	IT + Vendor	☐
Audit Logging	🔵 Verify all access logged, exportable	IT + Vendor	☐
Data Retention Policy	Aligns with organizational policy	Compliance	☐
Breach Notification SLA	🔵 Vendor commits to <24 hour notification	Legal	☐
Subprocessor List	🔵 All subprocessors reviewed and approved	IT Security	☐
Employee Training	🔵 Vendor certifies staff HIPAA trained	Compliance	☐
Physical Security	🔵 Data center certifications reviewed	IT Security	☐

Access Control Matrix

Role	View Eligibility	Run Verification	Modify Settings	View Reports	Admin Functions
Front Desk	✓	✓	✗	✗	✗
Office Manager	✓	✓	✓	✓	✗
Billing/Insurance	✓	✓	✗	✓	✗
Provider	✓	✗	✗	✗	✗
Regional Manager	✓	✗	✗	✓	✗
Central Admin	✓	✓	✓	✓	✓

Standardized vs. Location-Specific Configuration

Standardize Centrally (Template Settings)

☐ Payer ID mappings ☐ Standard coverage breakdown display format ☐ Verification trigger rules (when auto-verify fires) ☐ Alert thresholds (e.g., warn if deductible >$500) ☐ Data retention settings ☐ Audit log configuration ☐ SSO/authentication settings ☐ Report templates

Allow Local Discretion

☐ Notification preferences (email vs. in-app) ☐ Default view settings per user ☐ Appointment-type verification rules (if practices have different services) ☐ Local payer portal credentials (if not centralized) ☐ Office-specific workflow variations (within guardrails)

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6. Team Training Plan

Train-the-Trainer Model

Champion Selection Criteria

Criterion	Requirement
Role	Office Manager, Lead Front Desk, or Insurance Coordinator
Tenure	>6 months at location
Tech Comfort	Demonstrated proficiency with PMS and general software
Communication	Able to train peers without intimidating them
Availability	Can dedicate 8–10 hours to training program
Credibility	Respected by both front desk and providers

Champion Responsibilities

1. Pre-Go-Live

   • Complete Verifidental champion certification (4 hours)
   • Customize training materials for location context
   • Schedule and communicate training sessions to team

2. Go-Live Week

   • Lead daily huddles (15 minutes)
   • Provide real-time support as first escalation point
   • Log issues for central team review

3. Post-Go-Live

   • Train new hires within first week of employment
   • Lead monthly refresher sessions (30 minutes)
   • Participate in champion community calls

Champion Training Program (4 Hours)

Module	Duration	Format	Content
Module 1: Platform Fundamentals	60 min	🔵 Live virtual (Vendor-led)	System overview, navigation, key concepts
Module 2: Workflow Deep Dive	90 min	🔵 Live virtual (Vendor-led)	All verification scenarios, edge cases
Module 3: Troubleshooting	45 min	🔵 Live virtual (Vendor-led)	Common issues, when to escalate
Module