Software Review

Pearly Review (2026)

Pearly is a billing automation and revenue cycle management platform that does one thing exceptionally well -- it gets patients to pay their dental bills without your front desk chasing them. Founded in 2015 by Jeff Cole in Santa Barbara, California, Pearly integrates at the ledger level with over 80 practice management systems and puts collections on autopilot. Practices using the platform report a 33% boost to collection rates on average. If your aging A/R report keeps you up at night, Pearly might be the fix.
By The Molar Report|Updated April 5, 2026|5 min read
Our Take

Pearly is ledger-level integration with 80+ PMS platforms and a performance-based pricing model that aligns Pearly''s incentives with your collection results -- 33% average boost to collection rates.. Pearly is a billing automation and revenue cycle management platform that does one thing exceptionally well -- it gets patients to pay their dental bills without your front desk chasing them. Founded in 2015 by Jeff Cole in Santa Barbara, California, Pearly integrates at the ledger level with over 80 practice management systems and puts collections on autopilot. Practices using the platform report a 33% boost to collection rates on average. If your aging A/R report keeps you up at night, Pearly might be the fix.

Best ForPractices and DSOs with significant aging A/R who want automated patient billing and collections without adding staff. Performance-based pricing means you only pay when Pearly collects.
Key StrengthLedger-level integration with 80+ PMS platforms and a performance-based pricing model that aligns Pearly''s incentives with your collection results -- 33% average boost to collection rates.
Biggest DrawbackPerformance-based costs scale with collections volume

What Is Pearly?

Pearly is a revenue cycle management platform purpose-built for dental. It connects directly to your practice management software at the ledger level -- not a surface-level API -- and automates patient billing, payment collection, and accounts receivable management. Think of it as putting your most persistent collections person on autopilot, except it never takes a sick day and never offends a patient.

The platform covers the full billing lifecycle: automated digital statements, physical letter delivery for patients who ignore digital, custom online payment portals, flexible payment plans, and a reporting suite that shows you exactly where your money is stuck. Pearly also offers an in-house membership plan add-on for practices looking to capture uninsured patients with recurring revenue.

Jeff Cole and the CTO (who co-founded Path together) built Pearly after their healthcare messaging company was acquired in 2018. They brought the same automation-first mindset to dental billing -- the philosophy that anything your front desk does repeatedly should be handled by software.


Who Is It For?

Pearly targets any dental practice with meaningful patient balances, but the biggest impact shows up in practices with high A/R aging -- those with $50,000 or more sitting in 60-plus-day buckets. Solo practices benefit from the staff time savings. DSOs benefit from standardized collections across locations.

The 80-plus PMS integrations mean Pearly works with virtually any system you are already running. If you use Dentrix, Eaglesoft, Open Dental, Denticon, or any of the other major platforms, Pearly plugs in without requiring you to switch anything.


Key Features

Billing and A/R Automation: Automatically generates and sends patient statements via text, email, and physical mail. Escalation sequences move from gentle reminders to firmer notices based on aging. Patients get a frictionless online payment experience without your team lifting a finger.

Pay-Over-Time Payment Plans: Offer patients flexible financing directly from your practice -- no third-party lender taking a cut. You set the terms, Pearly manages the recurring billing. This is in-house financing without the administrative burden.

Custom Online Pay Portals: Branded payment pages where patients can view balances and pay 24/7. Mobile-optimized, which matters because most patients will pay from their phone.

Digital and Physical Statements: Automated statement generation and delivery. Pearly sends digital statements first, then escalates to printed letter statements for non-responders -- a surprisingly effective one-two punch.

Reporting and Analytics: Dashboard showing collection rates, A/R aging trends, payment plan performance, and per-patient balance tracking. You can see exactly which patients owe what and where the bottlenecks are.

Membership Plans (Add-On): In-house dental membership plan management for uninsured patients, including automated billing, renewals, and plan tracking.


Pros

  • No setup costs and no monthly subscription -- performance-based pricing
  • Integrates at the ledger level with 80+ practice management systems
  • Proven Pearly reports a 33% average boost to collection rates
  • Saves dozens of staff hours per month on billing and follow-up
  • Automated escalation from digital to physical statements
  • In-house payment plans without third-party financing fees

Cons

  • Performance-based pricing means costs scale with collections -- could get expensive for high-volume practices
  • Exact pricing is not published, so you cannot comparison-shop easily
  • Membership plan feature is an add-on, not included in base offering
  • Relatively small company with less brand recognition than competitors like Kleer or RevenueWell
  • Limited public reviews compared to more established platforms
  • Physical statement mailing adds cost that digital-only alternatives avoid

What We Like and What We Don't

What Works
  • No setup costs or monthly subscription fees
  • Integrates with 80+ PMS platforms at the ledger level
  • 33% average boost to collection rates
  • Saves dozens of staff hours monthly
  • Automated digital-to-physical statement escalation
  • In-house payment plans without third-party fees
What Doesn't
  • Performance-based costs scale with collections volume
  • Exact pricing not publicly available
  • Membership plans are an add-on
  • Smaller brand recognition than established competitors
  • Limited public user reviews
  • Physical statement mailing adds incremental cost

Who This Is For (and Who Should Look Elsewhere)

Pearly Is a Strong Fit If You...

  • No setup costs or monthly subscription fees
  • Integrates with 80+ PMS platforms at the ledger level
  • 33% average boost to collection rates
  • Saves dozens of staff hours monthly
  • Automated digital-to-physical statement escalation

You Should Look Elsewhere If You...

  • Performance-based costs scale with collections volume
  • Exact pricing not publicly available
  • Membership plans are an add-on
  • Smaller brand recognition than established competitors
  • Limited public user reviews

How It Compares

Pearly vs. Top AlternativesSee full comparisons →
PearlyPearlDentalMonitoring
TMR Score8.09.09.0
ArchitectureCloud-basedCloud-basedcloud-native
Starting PriceSubscriptionPer locationCustom
Best ForPractices and DSOs with significant aging A/R who want automated patient billing and collections without adding staff. Performance-based pricing means you only pay when Pearly collects.Any practice that wants AI-assisted radiograph analysis to catch missed pathology and improve case acceptance. Especially valuable for DSOs standardizing clinical quality across locations.Orthodontic practices and DSOs looking to reduce in-office visits by 45% while maintaining clinical control through AI-powered remote monitoring of aligner and braces treatments across all brands.

The Bottom Line

Pearly is a billing automation and revenue cycle management platform that does one thing exceptionally well -- it gets patients to pay their dental bills without your front desk chasing them. Founded in 2015 by Jeff Cole in Santa Barbara, California, Pearly integrates at the ledger level with over 80 practice management systems and puts collections on autopilot. Practices using the platform report a 33% boost to collection rates on average. If your aging A/R report keeps you up at night, Pearly might be the fix.

Our recommendation: If Pearly matches your practice profile, put it on your shortlist. Visit their site and make your decision based on the numbers and the fit.

This review is based on independent research. Read our methodology. Something look off? Let us know.