Acknowledged is not confirmed. NexHealth accepting a booking isn't the same as your PMS holding it. Anything still unconfirmed shows up in Needs attention.
We can only do what it exposes. Some Open Dental rules, like operatory constraints and provider blocks, aren't always visible to us. We stay conservative about what patients can self-book.
If NexHealth is down, we can't write. Conversations keep running and we take callbacks, rather than pretending a booking landed.