BOCA Prime focuses on several related pressures that affect how much practical value dental coverage can deliver to patients and practices.
Dental care costs, wages, and practice expenses change. When benefit structures and annual limits fail to keep pace, the same nominal benefit can purchase less care over time.
Prime explores a model in which care costs, contributions, utilization, reserves, financial risk, and system performance can inform how coverage evolves rather than allowing its practical value to stagnate simply because the underlying benefit structure remains unchanged.
Patients make treatment decisions at a specific moment. They want to understand what their coverage will support, what they may owe, and whether they can proceed with care.
Today, reaching those answers can involve benefit verification, manual interpretation, preauthorization, estimates, follow-up, and repeated handoffs—steps that consume staff time and can delay a patient’s ability to move forward with treatment.
Prime is being designed to establish more of that information earlier and more reliably, while it can still inform the decision.
Dental practices spend staff time verifying benefits, interpreting plan rules, submitting and resubmitting information, responding to requests, following payments, reconciling estimates, and explaining administrative uncertainty to patients.
Some of that work serves a necessary purpose.
Prime asks how much of it can be reduced, automated, or handled more consistently by the system itself without weakening clinical judgment, appropriate review, or accountability.
Resources used to administer coverage are resources that cannot also support benefits, reserves, provider payment, technology, oversight, or care.
Greater efficiency does not eliminate those competing responsibilities. It can create more room to meet them.
The larger objective is to make better use of the resources people already contribute for the purposes the coverage system is meant to serve.
A functioning coverage system has real responsibilities. It has to know who is participating, determine which rules apply, establish what support is available, verify required information, protect shared resources, maintain financial integrity, coordinate payment, and provide a way to handle uncertainty and exceptions.
Those responsibilities remain necessary even when the system around them changes.
Prime begins by separating each responsibility from the process currently used to perform it. It then asks how advancing technical capabilities can support clearer rules, more reliable information, greater automation and verification, and stronger financial controls—and where human judgment, review, or other safeguards still need to remain.
Rather than treating any one technology as the answer, Prime explores how those capabilities can work together around the actual responsibilities of coverage.
The design question is simple: if each necessary function were being organized deliberately today, how should it work?
Who is participating, and which rules apply?
What support is available under those rules?
What information must be established and trusted?
How are finite resources protected and obligations supported?
Once an obligation is established, what happens next?
What requires additional judgment, intervention, or accountability?
How can each responsibility be performed more clearly, efficiently, reliably, and accountably?
Imagine a patient sitting with their dentist after an examination, discussing recommended treatment.
This is the moment when coverage information is most useful. The patient is trying to understand what care is being recommended, what it will cost, what support their coverage may provide, and what responsibility will remain with them before deciding how to proceed.
The questions are practical:
What treatment is being recommended?
What does it cost?
Will my coverage apply?
What will it contribute?
What responsibility will remain with me?
Today, reaching a dependable answer can require verification, interpretation, preauthorization, estimates, follow-up, and repeated communication. That work takes time, and uncertainty can remain while a patient is trying to make a treatment decision.
Prime is being designed around a different experience.
Once the practice submits the recommended treatment and the information required under Prime’s rules, the system is intended to resolve more routine coverage questions quickly and communicate the result directly to both the patient and the practice.
The patient should be able to understand what Prime is expected to contribute and what responsibility may remain while that information can still help determine what happens next.
If a case requires additional review, the system should make that clear as well rather than leaving the patient or practice to reconstruct the status through repeated follow-up.
The responsibilities remain distinct:
The dentist recommends the care they believe is clinically appropriate.
The practice establishes its fee.
BOCA Prime applies its established rules and determines the financial support available.
The patient sees the expected Prime contribution and any remaining responsibility, then decides whether to proceed.
The intended result is a clearer relationship among clinical judgment, coverage, and patient choice—one in which financial information can be established and communicated more efficiently, so it is more useful when someone is deciding what to do.
Clinical judgment · Coverage support · Patient choice
A workable coverage model has to distribute finite resources across several legitimate responsibilities at the same time.
Patients need financial support that is meaningful enough to matter and clear enough to understand when treatment decisions are being made. Practices need a workable relationship between what they charge and what coverage contributes. And the system itself has to meet its coverage obligations, maintain appropriate reserves, account for changing utilization and costs, and support the infrastructure required to operate.
Prime’s current financial design explores a set of rules intended to make those relationships clearer: how support changes as eligible care accumulates during the coverage year, what amount Prime uses when calculating that support, and where its financial obligations are bounded.
The structure can be defined before every numerical parameter is settled. Prime already has working approaches for many of those parameters, but exact rates, thresholds, limits, contributions, and reserve requirements require further economic and actuarial validation.
Traditional dental plans often cover different percentages depending on the type of procedure being performed.
Prime’s leading model takes a different approach. The percentage Prime contributes would depend more on how much eligible dental care the participant has already used during that coverage year.
Prime would cover a higher percentage of the first portion of eligible dental costs during the coverage year, leaving a smaller share to the patient.
Once the participant has used that first portion, Prime would cover a lower percentage of the next portion, and the patient’s share would increase.
If spending continues, later portions would receive progressively less Prime support and a greater share would remain with the patient, up to the plan’s coverage-year limit.
This design makes coverage easier to understand and predict. Before treatment, the patient and practice should be able to see what Prime is expected to contribute, what responsibility remains with the patient, and how much support remains available for the rest of the coverage year.
Prime already has working assumptions for the percentages, thresholds, limits, and contribution levels. Those exact numbers require further economic and actuarial validation before becoming final plan terms.
Prime contributes the highest percentage.
Patient responsibility is lowest.
Prime contributes a lower percentage.
Patient responsibility increases.
Prime contributes progressively lower percentages.
Patient responsibility increases further, up to the coverage-year limit.
Prime does not set a mandatory fee schedule for participating practices. The practice submits the fee it actually charges for the recommended treatment.
That keeps the treatment price separate from the coverage decision and allows fees to reflect real differences among practices and local markets.
But Prime also needs a limit on its own financial exposure.
For each covered procedure, Prime would use regional pricing information to establish a maximum amount that can be used when calculating its contribution.
If the practice fee is at or below that regional limit, Prime would apply the participant’s current support percentage to the actual fee.
If the practice fee is above the regional limit, Prime would calculate its contribution using the regional limit instead.
The practice may still charge its submitted fee. The patient would be able to see the practice fee, Prime’s expected contribution, and the remaining responsibility before deciding whether to proceed.
The regional limit is one of several mechanisms intended to keep pricing and system exposure in balance. Additional safeguards—including market transparency, verified patient feedback, system monitoring, and other forms of oversight—are explored in Prime Economics & Safeguards.
Prime applies the current support percentage to the actual practice fee.
Prime applies the current support percentage to the regional limit.
Practice fee · Prime contribution · Remaining patient responsibility
The resources available to Prime have more than one job. The system has to support care, maintain appropriate reserves, and fund the infrastructure and oversight required to operate.
What Prime contributes toward eligible care.
Resources held to support future obligations and changes in utilization.
The infrastructure, compliance, security, administration, and human review required to keep the system functioning.
Those responsibilities have to be balanced together. More generous coverage affects the resources available for reserves. Higher utilization changes what the system may need to support. Operating costs matter as well.
Efficiency can create more room inside that equation. It cannot eliminate the equation.
Prime may also use outside capital and future treasury strategies to strengthen reserves and support growth. Those mechanisms are part of the broader economic architecture discussed in greater detail in Prime Economics & Safeguards.
Prime’s financial parameters should not remain fixed if actual experience shows that they need to change.
Over time, factors such as care costs, utilization, participant contributions, reserve performance, regional pricing, and overall system performance may justify adjustments to support percentages, limits, regional thresholds, reserve targets, or other financial rules.
Those changes would still have to preserve the financial health of the system. More generous support, for example, has to be considered alongside contributions, utilization, reserves, and other obligations.
Prime already has working approaches for these parameters, but the exact rates, thresholds, limits, contributions, and reserve requirements require further economic and actuarial validation before becoming final plan terms.
Prime is focused on coverage: establishing what support is available, applying the rules consistently, and coordinating that support with patients and practices.
But making that system work creates other requirements.
Participants and permissions have to remain trustworthy. Clinical evidence has to be evaluated. Money has to move. Patients may still face affordability gaps after coverage is applied. Important system rules may need to change over time.
Those requirements are what give rise to the broader architecture around Prime. Each component addresses a problem the coverage model cannot solve on its own. Together, they create capabilities for identity, verification, affordability, financial coordination, and system stewardship that can support Prime, become useful across the wider BOCA ecosystem, and—if they prove themselves there—potentially have applications beyond BOCA as well.
That broader architecture—and its future potential—takes shape through several connected systems:
Coverage coordination
A persistent connection between a real person and their digital participation.
Rootprint is Cadmus Labs’ framework for carrying identity, permissions, and trusted history forward over time—so trust does not have to be rebuilt from scratch at every interaction.
Inside BOCA, that continuity could support verified patient feedback, provider reputation, governance, future financing, and other functions where knowing who participated and preserving that history matters.
Rootprint gives digital identity a memory—allowing trust, reputation, and accountability to build over time instead of disappearing between interactions.
Verification, pattern recognition, and system intelligence.
Within Prime, DentAI is intended to help evaluate submitted evidence, identify missing or inconsistent information, and recognize activity that may require additional review.
As the system develops, that same ability to understand patterns across larger amounts of information could also support fraud, waste, and abuse detection, provider and utilization analysis, system monitoring, and other forms of dental intelligence.
Diagnosis and treatment recommendations remain the responsibility of the dentist.
Moving and managing value across the system.
Coverage ultimately creates financial obligations.
Contributions have to be collected. Providers have to be paid. Reserves and treasury resources have to be managed. Financial activity has to remain secure, accountable, and compatible with the legal and regulatory structure in which Prime operates.
Prime needs financial infrastructure that can work across today’s established payment systems while remaining ready for increasingly programmable forms of money, settlement, and asset ownership.
That could eventually include stablecoin settlement, tokenized assets, programmable payments, automated treasury functions, and other financial rails as those systems mature and become appropriate for use.
The aim is a financial layer that can support reliable payment and reserve management today while creating a path toward faster settlement, greater transparency, programmable execution, and participation in a financial system where more real-world value may move through digital and tokenized infrastructure.
Those capabilities also support a larger principle behind BOCA: Cadmus should earn its place by helping create and coordinate value, with increasingly transparent rules and a meaningful role for the people the system exists to serve.
Coverage can reduce cost. It cannot always make care affordable.
Even meaningful coverage may leave a patient with a remaining balance they cannot comfortably manage.
Rootline is the proposed financing layer for that gap.
Because Prime already establishes identity, provider relationships, treatment context, coverage activity, and financial history, Rootline could evaluate a financing request with far more context than a single application or credit score provides. Traditional underwriting could still be used where appropriate, but it would no longer have to be the only source of information.
Rootline could turn the history already built inside BOCA into useful underwriting context—creating the possibility of more informed, efficient financing tied to real care, real providers, and persistent identity.
How important rules change—and who has authority to change them.
A system intended to operate over many years cannot assume that every rule chosen at the beginning will remain appropriate forever.
Costs change. Utilization changes. Technology changes. Regulation changes. Evidence may show that an assumption was wrong or that a rule is being exploited.
Governance is the part of the architecture concerned with how those decisions are made, what authority different participants have, what limits apply, and how important changes can become more transparent and accountable over time.
Early operation would remain primarily under Cadmus, which would be responsible for running the system and meeting its legal and operational obligations. If Prime earns the evidence and maturity to support broader governance, certain system-level decisions could gradually include verified patients and participating dental practices under clearly defined rules for who can participate, what decisions they can influence, and what authority remains with Cadmus or other responsible parties.
Delegated action within defined permissions.
As software systems become more capable, patients, practices, and the system itself may increasingly use software to perform routine actions on their behalf.
That creates a different kind of question:
What is an agent allowed to do, who authorized it, what information may it access, and who remains accountable for its actions?
Cadmus is exploring how identity, permissions, rules, and verifiable authorization could allow authorized agents to participate in parts of the system—helping schedule appointments, submit routine information, make authorized payments, or follow up on coverage status—without giving them unrestricted authority.
This remains a longer-horizon capability, but the underlying requirement is already important: automation should act within permissions that can be established, limited, and verified.
Prime does not begin by asking where AI, blockchain, cryptography, decentralization, or these specialized systems just outlined can be inserted.
It begins with what the system needs to accomplish.
Some functions may be best handled with conventional software. AI may be useful where large amounts of evidence or behavior need to be evaluated. Cryptography may help where something needs to be verified without unnecessarily exposing the information behind it. Programmable infrastructure may help where established rules can move more directly toward execution. Distributed systems may become useful where independent verification, shared records, or shared control provide a real advantage.
And some responsibilities will continue to belong with people and institutions because judgment, accountability, law, or regulation require them.
Prime is therefore expected to be a hybrid architecture—using each approach where it provides a useful property rather than treating any one technology as the answer.
Read the Design Paper → Technology Follows PurposeThe Architectural Requirements Behind BOCA Prime
Prime should advance only where the evidence supports it.
The proposed architecture creates hypotheses about coverage, economics, technology, participation, and governance. Before those ideas become an operating system—or before an operating system expands—they have to survive scrutiny in the areas that determine whether Prime can work responsibly in the real world.
Can Prime operate within a lawful and workable regulatory structure in each market where it is introduced?
Can contributions, utilization, benefits, reserves, limits, and risk remain financially sustainable under realistic conditions?
Can the model create enough value for patients, practices, and the system to justify its costs and obligations?
Will patients and dental practices actually choose to participate—and remain engaged once the model is operating?
Can coverage rules, verification, review, and safeguards support legitimate care without improperly replacing professional clinical judgment?
Can the architecture perform its required functions reliably, including identity, verification, rules, payments, exceptions, and human review?
Can sensitive information remain appropriately protected while the system still establishes and verifies the facts it needs?
Can important decisions, authority, rule changes, and participant influence be structured with clear responsibility and meaningful safeguards?
Does the system continue to work when it encounters actual practices, patients, exceptions, edge cases, changing conditions, and sustained use?
These are not boxes to check once.
Evidence may support one part of the model while challenging another. The purpose of validation is to determine what deserves to move forward, what needs to change, and what should be abandoned.
A compelling idea earns investigation. Evidence earns implementation.
The ambition is intentional. So is the burden of proof.