Zuub — Implementation Playbook (DSO)

Zuub Implementation Playbook for DSOs

Revenue Cycle AI Deployment Guide

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1. Executive Summary

What Zuub Does

Zuub is an AI-powered revenue cycle management platform that automates insurance verification, eligibility checks, treatment plan optimization, and patient financial engagement. The platform integrates directly with practice management systems to provide real-time benefit breakdowns, automate pre-authorizations, reduce claim denials, and accelerate payment collection through intelligent patient payment solutions.

Why DSOs Benefit from Revenue Cycle AI at Scale

Revenue cycle AI delivers exponential returns for multi-location dental organizations:

• Standardization: Eliminate the variability in how 15–50 different front desk teams interpret insurance benefits and communicate patient responsibility—Zuub applies consistent logic across every location
• Data Aggregation: Aggregate denial patterns, payer behavior, and collection performance across your entire portfolio to identify systemic issues invisible at the location level
• Labor Efficiency: Centralize eligibility verification and pre-authorization workflows that currently consume 2–4 hours daily per location, reallocating FTEs to higher-value activities
• Cash Flow Acceleration: Reduce average days to payment across all locations through intelligent payment plan recommendations and automated patient engagement
• Scale Leverage: Negotiate with payers using portfolio-wide data on denial rates, processing times, and reimbursement patterns

Expected Timeline: Decision to Full Deployment

Phase	Duration	Milestone
Pre-Implementation	Weeks 1–2	Enterprise configuration complete
Wave 1 Pilot (2–3 locations)	Weeks 3–6	Pilot validation complete
Wave 2 Expansion (5–8 locations)	Weeks 7–12	Scaled deployment validated
Wave 3 Full Rollout (remaining locations)	Weeks 13–20	Full portfolio deployment
Optimization	Weeks 21–24	Baseline ROI achieved

Total: 20–24 weeks from contract signature to full deployment across 15–50 locations

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

Technical Requirements

Hardware

☐ Verify each location has workstations with minimum 8GB RAM, modern browser (Chrome/Edge latest version)
☐ Confirm front desk workstations have dual monitors (recommended for split-screen workflow)
☐ Inventory existing barcode scanners/card readers for patient ID capture if applicable

Software

☐ Document PMS version at each location (Dentrix, Eaglesoft, Open Dental, Denticon, etc.)
☐ Confirm PMS licensing includes API access where required
☐ Verify browser versions and update policies across locations

Network

☐ Minimum 25 Mbps download/10 Mbps upload per location ⚠️ Common failure point: rural locations with inadequate bandwidth
☐ Confirm Zuub domains are whitelisted on firewalls/content filters
☐ Test connectivity to Zuub endpoints from each location

Integrations

☐ Document current clearinghouse relationships (NEA, Tesia, Vyne, etc.)
☐ Inventory existing patient communication platforms (Weave, RevenueWell, etc.)
☐ Document any existing insurance verification tools that will be deprecated

Vendor Onboarding Steps

☐ 🔵 Schedule enterprise kickoff call with Zuub implementation team (Week 1, Day 1)
☐ 🔵 Assign dedicated Zuub Customer Success Manager and Technical Implementation Lead
☐ 🔵 Establish shared project management workspace (Zuub typically uses Monday.com or similar)
☐ 🔵 Complete Master Services Agreement and BAA execution
☐ Designate internal DSO project lead with authority to make implementation decisions
☐ 🔵 Request Zuub's enterprise onboarding documentation package

Key Vendor Contacts to Establish

Role	Purpose	Response Time SLA
Customer Success Manager	Strategic alignment, escalations	4 hours
Technical Implementation Lead	Integration, configuration	2 hours during implementation
Tier 2 Technical Support	Break/fix issues	1 hour
Executive Sponsor (Zuub side)	C-level escalations	24 hours

Data/Access Prerequisites

☐ Generate API credentials for each PMS instance (or enterprise API if available) ⚠️
☐ Create Zuub admin accounts for central operations team
☐ Establish role-based access control framework (who sees what data)
☐ Export sample claim data from 2–3 locations for test environment setup
☐ Compile payer mix report for each location (top 10 payers by volume)
☐ Document NPI numbers and Tax IDs for all billing entities

Internal Stakeholder Alignment

Stakeholder Alignment Map

Stakeholder	Role in Implementation	Engagement Requirement
🟣 Board/Investors	Approval of technology investment, ROI expectations	Monthly summary updates, quarterly business review
🟣 CEO/COO	Strategic sponsor, cross-functional coordination	Weekly status, decision-making on escalations
🟣 CFO	Budget approval, ROI validation	Pre/post metrics review, financial modeling
🟣 Chief Dental Officer	Provider workflow approval, clinical sign-off	Training content review, provider communication
VP of Operations	Day-to-day implementation oversight	Daily/weekly standups, wave approvals
IT Director	Technical integration, security compliance	Technical reviews, go-live support
Regional Managers	Location coordination, local escalations	Wave briefings, champion support
Office Managers	Local implementation lead, staff coordination	Training delivery, daily operations
Billing Manager/RCM Lead	Workflow redesign, metric ownership	Process mapping, KPI tracking
Providers	Workflow adoption, treatment plan optimization	Training, feedback loops
Front Desk Staff	Daily system users	Training, go-live support

Approval Matrix

Decision	Approver	Timeline
🟣 Contract execution	CFO + CEO	Pre-Week 1
🟣 Wave sequence approval	COO + Regional Managers	Week 2
🟣 Go/No-Go for Wave 2	VP Operations + CFO	End of Week 6
🟣 Workflow changes affecting patient experience	CDO + COO	Week 2
Configuration standards	VP Operations + IT Director	Week 2
Training curriculum approval	CDO + VP Operations	Week 2

Baseline Metrics to Capture

⚠️ Critical: Capture these metrics BEFORE go-live or ROI measurement becomes impossible

Financial Metrics (Capture per location)

☐ Average days to payment (insurance)
☐ Average days to payment (patient responsibility)
☐ Claim denial rate (% of claims denied on first submission)
☐ Claim denial by reason code (top 10 denial reasons)
☐ Average time to denial resolution
☐ Collection rate (% of billed amount collected within 90 days)
☐ Patient payment plan conversion rate
☐ Write-off rate

Operational Metrics (Capture per location)

☐ Average time spent on insurance verification per patient (time study)
☐ Average time spent on pre-authorization per case
☐ Number of eligibility-related patient complaints/reschedules monthly
☐ FTE hours allocated to insurance verification/billing tasks
☐ Number of treatment plans modified due to late eligibility discovery

Standardization Protocol

🟣 Executive Decision Required: Standardized methodology for metric capture across all locations

☐ Select 4-week baseline measurement period (recommend 4 weeks prior to Wave 1 go-live)
☐ Deploy standardized time tracking for verification/pre-auth tasks
☐ Export claims data from all locations using identical parameters
☐ Establish centralized baseline dashboard in Excel/BI tool
☐ Assign data collection owner per location
☐ Schedule data validation review before Wave 1 launch

Enterprise-Level Requirements

Network Standards Across Locations

☐ Document network topology (VPN, SD-WAN, direct internet)
☐ Confirm consistent firewall rules can be deployed across locations
☐ Verify DNS resolution consistency
☐ Establish minimum bandwidth requirements in location lease agreements for future sites

Hosting Model Decision

🟣 Executive Decision Required: Centralized vs. Location-Level Configuration

Approach	Pros	Cons	Recommended For
Centralized Enterprise Instance	Single dashboard, unified reporting, easier administration	Requires reliable WAN connectivity	DSOs with strong central operations, consistent PMS
Location-Level Instances	Local resilience, location autonomy	Complex reporting aggregation, more admin overhead	DSOs with heterogeneous PMS, recent acquisitions
Hybrid (Recommended)	Central reporting + local resilience	Moderate complexity	Most DSOs 15–50 locations

☐ 🔵 Confirm Zuub's support for selected hosting model

SSO Integration

☐ Document existing identity provider (Azure AD, Okta, Google Workspace)
☐ 🔵 Request Zuub's SSO integration requirements (SAML 2.0, OIDC)
☐ Plan SSO configuration for pilot vs. full rollout
☐ Document role mapping from IdP groups to Zuub permissions

Centralized Credentialing

☐ Compile provider NPI roster across all locations
☐ Document payer enrollment status by provider by location
☐ Establish process for adding new providers to Zuub
☐ Define credentialing data owner (central vs. location)

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3. Location Readiness Assessment

Scoring Framework

Score each location on the following factors using a 1–5 scale. Multiply by the weight factor for a composite score (maximum 100 points).

Factor 1: IT Infrastructure Maturity (Weight: 2.0)

Score	Criteria
5	Fiber internet (100+ Mbps), current-generation workstations (<3 years old), modern PMS version
4	Cable internet (50+ Mbps), workstations 3–4 years old, PMS within 1 version of current
3	Cable internet (25+ Mbps), workstations 4–5 years old, PMS within 2 versions of current
2	DSL/limited internet, workstations 5+ years old, outdated PMS version
1	Unreliable internet, aging hardware with performance issues, legacy PMS

Factor 2: Staff Tenure and Adaptability (Weight: 2.0)

Score	Criteria
5	Average front desk tenure >3 years, demonstrated success with prior tech implementations, low turnover (<15% annually)
4	Average tenure 2–3 years, moderate tech comfort, turnover 15–25%
3	Average tenure 1–2 years, mixed tech adoption history, turnover 25–35%
2	Average tenure <1 year, resistance to prior changes, turnover 35–50%
1	High turnover (>50%), multiple recent staff changes, no stable leadership

Factor 3: Patient Volume (Weight: 1.5)

Score	Criteria	Rationale
5	400–600 patients/month	Optimal: high impact, manageable volume
4	600–800 patients/month	High impact, moderate complexity
3	800–1000 patients/month	High impact but higher go-live risk
2	200–400 patients/month	Lower impact, but safe for piloting
1	<200 or >1000 patients/month	Too low for meaningful learning OR too high for safe pilot

Factor 4: Tech Stack Compatibility (Weight: 2.0)

Score	Criteria
5	Standard PMS (Dentrix/Eaglesoft/Open Dental), no conflicting verification tools, standard clearinghouse
4	Standard PMS, one integration requiring coordination
3	Non-standard PMS with Zuub integration available, some workflow adaptation required
2	PMS with limited integration capability, multiple conflicting tools
1	Custom/legacy PMS, significant integration development required

Factor 5: Local Champion Availability (Weight: 2.5)

Score	Criteria
5	Tech-forward Office Manager + engaged provider both volunteering to champion
4	Strong Office Manager champion, provider supportive
3	Office Manager willing to champion, provider neutral
2	Office Manager resistant but compliant, no provider engagement
1	No willing champion, active resistance from leadership

Composite Score Calculation

Factor	Weight	Location Score	Weighted Score
IT Infrastructure	2.0	___	___
Staff Tenure/Adaptability	2.0	___	___
Patient Volume	1.5	___	___
Tech Stack Compatibility	2.0	___	___
Local Champion	2.5	___	___
Total	10.0	—	/50

Readiness Tiers

Score	Tier	Recommendation
40–50	A - High Readiness	Wave 1 candidate
30–39	B - Moderate Readiness	Wave 2 candidate
20–29	C - Developing Readiness	Wave 3, with remediation plan
<20	D - Not Ready	Remediate before including in rollout

Recommended Rollout Sequence

Wave 1 Selection Criteria (2–3 locations)

• Tier A readiness score
• Geographic diversity (test support logistics)
• Representative of portfolio mix (1 general, 1 specialty if applicable)
• Office Manager with prior implementation experience
• Avoid: flagship locations, locations with concurrent major changes, recently acquired practices

Wave 2 Selection Criteria (5–8 locations)

• Tier A and upper Tier B locations
• Regional clustering (efficient training delivery)
• Include locations with common PMS variations to stress-test integrations

Wave 3 Selection Criteria (remaining locations)

• All Tier B and remediated Tier C locations
• Build remediation timeline into Wave 3 prep

Sample Location Readiness Matrix

Location	IT Score	Staff Score	Volume Score	Tech Score	Champion Score	Total	Wave
Downtown Main	5	4	4	5	5	45	1
Suburban North	4	5	5	4	4	44	1
Eastside Family	4	3	3	4	5	38	2
Specialty Ortho	3	4	3	3	4	34	2
New Acquisition	2	2	3	2	2	22	3*

*Requires remediation plan

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4. Rollout Strategy

Wave Structure Recommendation

Wave 1: Pilot Validation (2–3 Locations)

Duration: 4 weeks active + 1 week learning capture
Purpose: Validate configuration, training model, and identify portfolio-specific issues

Wave 2: Scaled Deployment (5–8 Locations)

Duration: 5 weeks active + 1 week learning capture
Purpose: Validate train-the-trainer model, stress-test support capacity

Wave 3: Full Rollout (Remaining Locations)

Duration: 6–8 weeks (can parallelize regional clusters)
Purpose: Complete deployment, establish BAU operations

Detailed Wave Timeline

Wave 1 Timeline (Weeks 3–7)

Week	Activity
Week 3	Champion training (intensive, in-person preferred), test environment validation
Week 4	Staff training at pilot locations, parallel run begins
Week 5	Go-live, daily check-ins, intensive support
Week 6	Stabilization, workflow refinement, metrics collection
Week 7	Learning capture session, Go/No-Go decision for Wave 2

Wave 1 Location Selection Criteria

☐ Composite readiness score ≥40
☐ Office Manager with 2+ years tenure at location
☐ No major concurrent changes (construction, provider changes, PMS migration)
☐ Different regional managers represented (test regional support model)
☐ At least one location with your most common payer mix
☐ Avoid: Your highest-revenue location, newest acquisitions, locations with union staff

Go/No-Go Criteria: Wave 1 → Wave 2

🟣 Executive Decision Required

Criteria	Green (Proceed)	Yellow (Proceed w/ Caution)	Red (Hold)
System uptime	>99%	97–99%	<97%
Integration errors	<2% of transactions	2–5% of transactions	>5% of transactions
Staff adoption	>90% using as primary workflow	75–90%	<75%
Eligibility accuracy	Equal or better than manual	Within 5% of manual	Worse than manual by >5%
Champion confidence	Champions request to proceed	Champions neutral	Champions request delay
Patient complaints	Zero related to Zuub	1–2 minor issues	Any significant complaints

Decision protocol: VP Operations and CFO review metrics. Two or more Yellow criteria require COO approval. Any Red criteria triggers 2-week remediation period.

Wave 2 Timeline (Weeks 8–13)

Week	Activity
Week 8	Champion training (can be regional groups), Wave 1 lessons incorporated
Week 9	Staff training (champion-delivered), test validation
Week 10	Go-live for Wave 2a (first 4 locations)
Week 11	Go-live for Wave 2b (remaining locations), daily check-ins
Week 12	Stabilization, cross-location metrics comparison
Week 13	Learning capture, Go/No-Go for Wave 3

Go/No-Go Criteria: Wave 2 → Wave 3

Criteria	Green	Yellow	Red
All Wave 1 criteria	Met	Met with exceptions	Not met
Train-the-trainer effectiveness	>85% staff trained by champions	70–85%	<70%
Cross-location consistency	Metrics within 15% range	15–25% range	>25% range
Support ticket volume	<3 per location per week	3–6 per location	>6 per location
Champion scalability	Champions managing without burnout	Champions stressed but managing	Champion turnover or escalations

Wave 3 Timeline (Weeks 14–20+)

Week	Activity
Week 14	Regional champion training (if new regions)
Weeks 15–16	Regional cluster 1 go-live (5–8 locations)
Weeks 17–18	Regional cluster 2 go-live (5–8 locations)
Weeks 19–20	Remaining locations go-live
Weeks 21–24	Stabilization, optimization, full portfolio metrics

Rollback Plan

Rollback Triggers

• System unavailable >4 hours during business hours
• Integration errors affecting >10% of transactions for >2 consecutive days
• Patient financial errors resulting in billing complaints
• Champion requests emergency pause
• Provider refusal to continue using system

Rollback Procedure (Per Location)

Step	Action	Owner	Timeline
1	Regional Manager approves pause	Regional Manager	Immediate
2	Revert to manual verification workflow	Office Manager	Within 1 hour
3	Notify central team and Zuub	Champion	Within 1 hour
4	Document failure mode	Champion + IT	Within 24 hours
5	Root cause analysis	IT + Zuub	Within 48 hours
6	Remediation plan	VP Operations + Zuub	Within 1 week
7	Re-deployment	Per plan	Variable

Isolation Protocol

• Rollback at one location does NOT trigger pause at other locations
• Regional Manager assesses if issue is systemic (affecting multiple locations in wave)
• If systemic: escalate to VP Operations for wave-level decision
• Other waves continue unless explicit hold from VP Operations

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5. Configuration & Integration (Weeks 2–3)

Practice Management System Integration

Dentrix Integration

Step	Action	Owner	Time Estimate
1	Verify Dentrix version (minimum G7.x for full integration)	IT	15 min/location
2	Enable Dentrix API access in eCentral	IT	30 min
3	🔵 Request Dentrix API credentials from Henry Schein if not already available	IT + Zuub	3–5 days ⚠️
4	🔵 Configure Zuub connector with Dentrix credentials	Zuub	1 hour
5	Test patient demographic sync (10 test patients)	Champion	30 min
6	Test insurance data flow (both directions)	Champion	30 min
7	Test treatment plan sync	Champion	30 min
8	Validate claim data mapping	Billing Manager	1 hour
9	Enable production sync	IT + Zuub	15 min

⚠️ Common failure point: Dentrix API credentials often take longer than expected. Start this process in Week 1.

Eaglesoft Integration

Step	Action	Owner	Time Estimate
1	Verify Eaglesoft version (21.x or higher recommended)	IT	15 min/location
2	Enable Eaglesoft database access (requires Patterson coordination)	IT	1–3 days
3	🔵 Configure Zuub database connector	Zuub	2 hours
4	Test patient/insurance sync	Champion	30 min
5	Configure real-time vs. batch sync preference	IT + Zuub	30 min
6	Validate appointment integration	Champion	30 min
7	Production enablement	IT + Zuub	15 min

Open Dental Integration

Step	Action	Owner	Time Estimate
1	Verify Open Dental version and hosting (cloud vs. local)	IT	15 min/location
2	Enable Open Dental API in Program Properties	IT	15 min
3	🔵 Generate API key in Open Dental, provide to Zuub	IT	15 min
4	🔵 Configure Zuub Open Dental integration	Zuub	1 hour
5	Test bidirectional sync	Champion	30 min
6	Production enablement	IT + Zuub	15 min

Enterprise PMS Considerations

☐ 🟣 Decision Required: Centralized API management or per-location credentials?

Approach	When to Use
Centralized credentials	Same PMS across all locations, enterprise license agreement
Per-location credentials	Mixed PMS environment, location-level licensing

Clearinghouse Integration

Step	Action	Owner	Time Estimate
1	Document current clearinghouse(s) per location	Billing Manager	2 hours
2	🔵 Confirm Zuub integration availability with each clearinghouse	Zuub	1 hour
3	Decision: route claims through Zuub or maintain existing submission path	Billing Manager + Zuub	🟣
4	Configure ERA/EOB data flow into Zuub	Zuub + IT	2 hours
5	Test claim submission and reconciliation	Billing Manager	2 hours

Test Environment Setup

Centralized Test Environment (Recommended)

Step	Action	Owner	Time Estimate
1	🔵 Request sandbox environment from Zuub	IT	24 hours
2	Configure sandbox with representative sample data (de-identified)	IT + Zuub	4 hours
3	Connect sandbox to test PMS instance (if available)	IT	2 hours
4	Create test user accounts for all trainers/champions	IT	1 hour
5	Develop test scripts for common workflows	VP Operations + Zuub	4 hours

Test Validation Checklist

☐ Patient lookup returns correct data
☐ Insurance eligibility check returns accurate benefits
☐ Real-time eligibility matches manual verification for 10 test cases ⚠️
☐ Treatment plan cost estimate calculates correctly
☐ Patient payment estimate displays accurately
☐ Claim submission routes to correct clearinghouse
☐ ERA data imports and matches correctly
☐ Reporting dashboard populates with test data

Data Migration/Historical Data

Step	Action	Owner	Time Estimate
1	🟣 Determine historical data scope (how far back?)	VP Operations + Zuub	Decision required
2	Export historical claims data (12–24 months recommended)	IT	4 hours/location
3	Export patient insurance history	IT	2 hours/location
4	🔵 Zuub data ingestion	Zuub	1–2 days
5	Validate historical data accuracy (sample check)	Billing Manager	2 hours

Recommendation: 18 months of historical data provides optimal baseline for AI learning while remaining manageable. Extend to 24 months if data quality is high.

Security and HIPAA Compliance

Enterprise HIPAA Checklist

☐ 🔵 Executed Business Associate Agreement (BAA) with Zuub
☐ Documented Zuub's SOC 2 Type II certification
☐ Verified Zuub data encryption (in transit and at rest)
☐ Confirmed data residency (US-based servers)
☐ Reviewed Zuub's breach notification procedures

Access Controls

☐ Defined role-based access matrix
☐ Configured SSO integration (or documented plan)
☐ Enabled audit logging for all PHI access
☐ Documented user provisioning/de-provisioning process
☐ Established minimum necessary access principle in configuration

Data Governance

☐ 🟣 Designated Data Privacy Officer oversight for implementation
☐ Documented data flow diagram (PMS → Zuub → Clearinghouse → Payer)
☐ Established data retention policy within Zuub
☐ Confirmed Zuub data deletion capabilities (right to erasure)
☐ Reviewed Zuub's subprocessor list

Standardized vs. Location-Specific Configuration

Standardized Configuration Template (Central Mandate)

Setting	Standard Value	Rationale
Eligibility check timing	72 hours pre-appointment	Consistent patient experience
Patient communication templates	Central-approved	Brand consistency
Payment plan options	4, 8, 12 month terms	Financial standardization
Denial follow-up workflow	Auto-queue at 48 hours	Collections consistency
User permission levels	Standardized role templates	Security compliance
Reporting dashboards	Central template	Cross-location comparison

Location-Specific Configuration (Local Discretion)

Setting	Variation Allowed	Approval Required
Provider treatment preferences	Per provider	None
Specialty-specific codes	By practice type	None
Local payer quirks	Per location	Document only
Office hour scheduling	Per location	None
Patient payment messaging tone	Minor adjustments	Regional Manager

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6. Team Training Plan

Train-the-Trainer Model

Champion Selection Criteria

Criteria	Weight	Scoring
Tenure at location	20%	2+ years = 5, 1–2 years = 3, <1 year = 1
Technical aptitude	25%	Prior tech implementation success
Peer influence	25%	Respected by team, informal leader
Availability	15%	Can dedicate 5+ hours/week during implementation
Communication skills	15%	Can teach, patient with questions

Target: 1 champion per location. For locations >8 FTEs, consider 2 champions (front desk + billing).

Champion Responsibilities

Phase	Responsibility	Time Commitment
Training	Attend central training, become certified	8–12 hours
Pre-Go-Live	Train location staff, answer questions	6–8 hours
Go-Live Week	On-site support, first-line troubleshooting	15–20 hours
Post-Launch Month 1	Ongoing support, feedback collection	3–5 hours/week
Steady State	New hire training, refresher delivery	2 hours/month

Champion Training Curriculum (Central Delivery)

Format: Live virtual + hands-on lab (8 hours total, recommend split across 2 days)

Session	Duration	Content
Module 1: System Overview	1.5 hours	Architecture, key features, DSO customizations
Module 2: Core Workflows	2 hours	Eligibility, verification, treatment planning, payments
Module 3: Hands-On Lab	2 hours	Guided exercises in test environment
Module 4: Troubleshooting	1 hour	Common issues, escalation paths
Module 5: Training Delivery	1 hour	How to train your team, adult learning principles
Module 6: Certification Test	0.5 hours	Must pass 85% to certify

🔵 Zuub delivers Module 1–4 content; VP Operations/Training team delivers Module 5–6

Training Completion Tracking

☐ Create master tracking spreadsheet: Location | Role | Name | Training Date | Certification Status
☐ Set go-live gate: 100% of front desk/billing staff trained before location go-live
☐ Set go-live gate: 90% of providers trained (100% for hygienists with eligibility touchpoints)
☐ Champion submits training completion report 48 hours before scheduled go-live
☐ Central team validates before authorizing go-live

Role-Specific Training Outlines

Providers (Dentists, Specialists)

Estimated Training Time: 45 minutes
Format: 15-minute video + 30-minute live demo with Q&A