Sections

Before you start: Upload source reports (for data verification). After you confirm you’re done uploading, the rest of the data entry sections will appear.

Required documents checklist (must check all)

If a required item is missing, the assessment can’t be delivered.

Current office fee schedule (UCR) Each in-network payer’s fee schedule directly from the insurance company (not PMS printout) Production + Collections report (last 12 months) Production + Collections report (last 5 calendar years) Write-offs report (insurance participation-related) Adjustments report (manual categories: discounts, redo, etc.) Patient A/R aging report that excludes credit balances (credits separate) Patient credit balances report (separate) Insurance A/R aging report Insurance write-offs by payer (last 12 months)

Upload documents (PDF/CSV/Excel/Images). You can upload multiple files.

Tip: name files clearly (e.g., “Patient AR Aging (No Credits)”, “Delta Fee Schedule Direct.pdf”).

I confirm I have uploaded all documents for this assessment I have no more reports to upload right now.

Once confirmed, the data entry sections will appear. You can still return to this step later and upload additional files if needed.

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Accounts Receivable (A/R) aging

Patient A/R aging must exclude credit balances. Credits must be entered separately.

Patient A/R (exclude credit balances)

Current

0–30

31–60

61–90

91+

Patient credits (separate)

Insurance A/R

Current

0–30

31–60

61–90

91+

Live A/R chart

Green = Patient A/R, Blue = Insurance A/R, Red = Patient credits.

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Calendar-year financials (separated by year)

Enter the last 5 calendar years (or add more rows if needed). Each year is separate (not combined).

Year	Gross Production	Adjustments	Write-offs	Collections

+ Add year

Live financials chart

This chart includes your calendar years plus a final column for “Last 12 months” totals (from the next section).

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Last 12 months (totals + breakdowns)

Enter totals for production and collections. Then break down manual adjustments by type and insurance write-offs by payer.

Production total (last 12 months)

Collections total (last 12 months)

Adjustments by type (manual categories)

Examples: redo treatment, senior citizen discount, membership discount, professional discount, etc.

+ Add adjustment type

Calculated total adjustments (last 12 months)

Insurance write-offs by insurance company (last 12 months)

Enter totals per in-network payer/umbrella.

+ Add insurance company write-off

Calculated total insurance write-offs (last 12 months)

Adjustments by type (pie)

Insurance write-offs by payer (pie)

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Practice details + local demographics (ZIP)

Demographics auto-fill after you enter a ZIP (median household income, bachelor’s+ %, poverty %).

Practice name

Primary practice management software Select… Dentrix Dentrix Enterprise / DXOne Open Dental Eaglesoft Curve Dental CareStack Denticon Other

Street address

Suite / Unit

City

State

ZIP

Fetch demographics

Median household income

% Bachelor’s degree or higher

% Below poverty level

Software-specific report help (starter)

Practice type (specialty)

General Dentistry Oral Surgery Endodontics Pediatrics Periodontics Prosthodontics Orthodontics

General Dentistry: enhanced services offered

Check all that apply.

Implant Placement Veneers Clear Aligners Traditional wire & bracket orthodontics In-office whitening

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Doctors

Add every doctor. Include role and years.

+ Add doctor

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Team members, wages, benefits

Why we ask: practice success is closely tied to team loyalty. Each assessment considers whether wages/benefits are competitive for private practice dentistry.

+ Add team member

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Marketing activity

Website/SEO, Google Ads, social ads, community, etc. Add lines as needed.

+ Add marketing line

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Insurance participation (networks / umbrellas)

List each network/umbrella, years participating, and last fee increase date.

+ Add insurance network

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Review & submit

If your WordPress endpoint isn’t wired yet, use “Download JSON”. File uploads require a server endpoint.

Download JSON Submit (endpoint placeholder)

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