by Matt Rej
CareStack is a cloud-based practice management solution for dentists, DSOs, and specialty practices. With more than 3,000 practices currently using the software, it’s far from the most popular option on the market but it’s big enough that we get enough questions about it.
Credit card processing fees will exceed the software costs for the vast majority of practices. So choosing the right setup is more important than you might initially think because the options aren’t interchangeable.
You essentially have three options:
- CS Pay: CareStack’s in-house payment processing solution.
- Integrate with a supported processor: Adyen, BluePay, or Rectangle
- Keep your existing processor
And of those three options, the only two I’d consider or recommend would be:
- Keep your processor
- Adyen
In that order.
That’s the short version. But I’ll explain what’s unique about each payment processing setup below so you can make that decision for yourself.
CS Pay
CareStack Pay is what’s going to be pushed on you hardest on CareStack’s website, marketing materials, and any rep you speak to. That’s because CareStack stands to make the most money if you go with this option.
It’s their own in-house payment solution, even though they aren’t technically a payment processor.
I’ve done this long enough to spot the tell-tale signs of a PayFac, and that’s exactly what this is. If you look closer at their knowledge base materials, you can see multiple references of a “sub-merchant agreement” mentioned on the CS Pay onboarding flow.
This means CareStack has the main merchant account with a backend processor, and you’re a sub-merchant below them. CareStack technically “facilitates” the payment rather than processes it (hence the name, payment facilitator or PayFac for short).
I believe Apex Payments is handling this for them on the backend. I can’t technically verify it because that information is hidden. But CareStack’s logo appears on Apex’s website, and this is exactly one of the services that they offer.
Though it honestly doesn’t matter who’s powering CS Pay on the backend. The practical takeaway is that this setup is always going to be more expensive because you’re dealing with a middleman. CareStack has to set your rates high enough so they can profit on top of whatever the backend processor is earning.
So despite the perceived simplicity of getting “everything under one roof” or “all-in-one,” I’d avoid this path purely from a cost perspective.
Adyen
Adyen is the only integrated processor supported by CareStack that doubles as an acquiring bank. What this means is that you’re going straight to the source and cutting out the middleman.
You can get a merchant account and your own MID directly from Adyen, and they handle all of your processing and support.
And of all the payment processors on the market, Adyen is truly one of the best because:
- They offer interchange-plus pricing
- Rates are actually competitive (honestly cheaper than most)
- Junk fees, hidden markups, and rate increases are practically non-existent
- Their technology is genuinely very good
I spend a lot of my time criticizing processors but Adyen is one that I have a hard time picking a bone with.
Now an integrated setup like this is going to cost more than using Adyen as a standalone option. But it should still be competitive and cheaper than whatever your effective rate would be with CS Pay or the other options.
BluePay
BluePay is somewhat unique because technically the brand doesn’t exist anymore. It’s folded into CardConnect, which is a Fiserv company. But the BluePay gateway still exists and functions.
If you want to use it, you’ll be going through CardConnect/Fiserv.
Fiserv is solid, and like Adyen, they’re also an acquiring bank. But the BluePay gateway sitting between is the reason why I said Adyen is the only direct acquirer on the list (Fiserv is the acquirer, not BluePay).
What this means is that Fiserv will be processing your transactions on the backend.
That’s not the worst thing that could happen. Fiserv is above average compared to other acquirers but they definitely have bigger issues than Adyen.
Rates can be fair but not always. And while statements are generally transparent, we do find junk fees during audits.
Historically, they didn’t raise rates often. But now we’re seeing increases about once per year. Not ideal, especially when you’re already paying a premium for an integrated setup.
Rectangle Health
Rectangle is a medical-specific payment processing solution, which fits the bill for CareStack.
You’re likely going to be on a flat-rate pricing plan if you go with them, which sounds simple but it’s more expensive. They generally reserve interchange-plus setups for really high-volume accounts.
One positive is that they do negotiate. And if you look at our Rectangle Health review, you can see examples of four different accounts paying four different fees.
But Rectangle is known for being expensive. Their rates just aren’t as competitive compared to other options unless you really get a good deal.
And unfortunately, Rectangle notoriously holds the record for the longest outage in the history of the payment processing space. Businesses relying on Rectangle for processing were unable to process cards for over 3 weeks, which is obviously unacceptable.
Everything has been restored and no incidents since. But that’s the kind of thing that’s just so hard to ignore because it’s honestly unheard of.
Keeping Your Own Payment Processor With CareStack Dental
Integrated payment processing with CareStack Dental is convenient, but not mandatory. So unless your existing processor is one of the three options listed above, you can’t get a direct integration.
But talk to your processor. It’s possible they can set you up with a gateway workaround.
If not, just keep your processing separate from CareStack. Use CareStack for operations and then pull the payment data after.
You’ll save a ton of money this way both in the short and long-term. Here’s why:
- Payment integrations command a premium price
- So if your processor isn’t integrated, your standalone setup should cost less
- You have direct access to the processor without a middleman or third party sitting between you
- Switching processors is expensive both in direct fees and operationally
- Your processor doesn’t want to lose your account, so you can negotiate a better rate directly with them for staying
Be upfront with your processor.
Tell them you’d like to stay with them but you really want to go the integrated route with your practice management. Since they’re unable to support that ask, see if they’ll offer you a concession elsewhere.
It could be waiving fees, a basis point reduction on your discount rate, or something else. But it’s definitely worth asking.
This way you can keep everything the same and just pay less for it.
Final Thoughts
Having your dental practice management software intertwined with credit card processing can be a perk, but at what cost?
Paying a slight premium can be justified if the convenience genuinely saves you time and money elsewhere. But many practices underestimate the added costs of using an in-house option like CS Pay.
Keeping your current processor is almost always going to be the cheapest option. And you can always negotiate a better rate directly with them.
Adyen will generally be the next cheapest option available. But prices vary by merchant account, and you should have someone look at your rates regardless of who’s processing payments for your dental practice.
No matter who you end up using, you can always negotiate a better deal directly with that provider. So don’t take their pricing at face value.