Cerbo + Twilio Integration

Complete Guide: About, Setup, & Usage

Overview

About the Twilio Integration

Cerbo offers an optional integration with Twilio that enables your practice to send and receive text messages and make outbound calls directly from the EHR. This integration connects Cerbo to a Twilio account that you own and manage — Cerbo uses Twilio's APIs to power the communication features, but your practice is responsible for the Twilio account itself, including setup, compliance registration, and billing.

What the Integration Does

1. Incoming texts to your Twilio number appear in a "Received Texts" block on your Cerbo scheduling page.
2. Any texts received from a patient's mobile number, or sent from their chart in Cerbo, are logged in their SMS history in their chart.
3. You can view a patient's SMS history or send them an SMS by clicking their mobile number in the Patient Information block.
4. SMS appointment reminders are sent from your Twilio number, so patients can reply directly — and their reply appears in the Received Texts block and is logged in their chart.
5. You can place outbound calls through your Twilio number by clicking a patient's phone number in their Patient Information block. Twilio calls your phone first, then connects you to the patient. The patient sees your Twilio number as the caller ID.

Costs

There is no additional charge from Cerbo for this integration. However, you will incur costs directly through your Twilio account. Typical costs at the time of this writing include approximately $0.75 per 100 SMS messages, and calling rates starting at $0.0085/min to receive and $0.013/min to place. These costs can add up if you use your Twilio number as your main clinic line with high call volume. All Twilio usage charges are billed directly by Twilio to your account.
 

Table of Contents

1. How Calls and Texts are Routed
2. HIPAA Consideration
3. Cerbo's Relationship with Twilio
4. Registration Requirements
5. Setting Up the Integration
6. Using the Integration
7. Troubleshooting & Support
8. Common Issues
9. Scope of Cerbo Support + Resources
    

Details

How Calls and Texts Are Routed

You can configure how incoming calls and texts to your Twilio number are handled — including routing them to different phone numbers during business hours vs. after hours. This is managed under Admin > Manage > Integrations (scroll to the Twilio section and select Manage Phone Numbers).

📝 Note on Text Routing
You can configure texts forward to a mobile phone number, but if you reply from your personal mobile, patients will see your personal number — not your Twilio number. For this reason, it is generally best to log in to Cerbo to view and respond to patient texts.

What Gets Logged

1. Text messages sent to or from your Twilio number are logged and shown in the patient's chart.
2. Calls to/from your Twilio number are logged, but the call log is not currently shown in the patient's chart in the EMR.

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HIPAA Consideration

⚠️ HIPAA Notice

Texting is generally not considered HIPAA-compliant, as SMS messages are not encrypted. If you wish to use Twilio texting with patients, we recommend obtaining patient consent — either through a consent form or by having patients opt in on the Account Details page of the patient portal — and ensuring patients understand that texting is not 100% secure.

The specific content required in a communication consent form is a legal determination that varies by practice type, state, and applicable regulations. Cerbo is not able to advise on what consent language is legally sufficient for your practice. We recommend consulting with a healthcare attorney or your compliance officer to ensure your consent process meets applicable requirements.

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Cerbo's Relationship with Twilio

Cerbo's relationship with Twilio is purely technical. Cerbo does not own or administer customer Twilio accounts and does not have a direct Twilio support line. Most Twilio-specific issues — including account setup, phone number management, compliance registration, and billing — must be resolved directly with Twilio Support.

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A2P 10DLC Registration: Required Before You Can Text

What Is A2P 10DLC?

A2P 10DLC (Application-to-Person 10-Digit Long Code) is a mandatory compliance framework established by U.S. mobile carriers — including AT&T, T-Mobile, and Verizon. It requires businesses to register their brand and messaging campaigns before sending text messages via 10-digit local phone numbers. Without registration, your messages may be filtered, blocked, or significantly delayed by carriers.

⚠️ Important: Complete Registration Before Configuring Cerbo

You must complete your A2P 10DLC Brand and Campaign registration in Twilio before configuring the Twilio integration in Cerbo. Attempting to send text messages before registration is approved will result in failed or blocked messages. Cerbo cannot assist in resolving delivery failures caused by incomplete registration.
 

What Registration Involves

Registration is completed in your Twilio Console and consists of two required steps:

1. Brand Registration — Register your practice as a business entity. Your legal business name, EIN, address, and contact information must exactly match your IRS records.
2. Campaign Registration — Register the type of messages you will send (e.g., appointment reminders, patient notifications). Each campaign type has its own registration and monthly fee.

For a full walkthrough of the registration process, refer to Twilio's documentation: A2P 10DLC Direct Standard Onboarding.

Registration Fees

There are fees associated with A2P 10DLC registration charged directly by Twilio and The Campaign Registry, including one-time brand registration fees, one-time campaign registration fees, and ongoing monthly campaign fees. For current pricing, refer to Twilio's official resource: What pricing and fees are associated with the A2P 10DLC service?.

Cerbo's Role in Registration

Cerbo is not able to complete A2P 10DLC registration on your behalf and is generally unable to advise on registration specifics — including which brand type to select, how to complete campaign details, or why a registration may be pending or rejected. These decisions are governed by Twilio and The Campaign Registry. If you have questions during the registration process, contact Twilio Support directly via your Twilio Console.

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Setting Up Your Twilio Integration

Setting up the Twilio integration involves three phases: creating and configuring your Twilio account, sending Cerbo your credentials, and configuring webhooks in Twilio. Complete all steps in order before attempting to use the integration.
 

1. Create and Configure Your Twilio Account

Go to twilio.com and create your account. When prompted with initial setup questions, answer as follows:

1. Which Twilio product are you here to use? SMS
2. What do you plan to build with Twilio? Alerts & Notifications
3. How do you want to build with Twilio? With no code at all
4. What is your goal today? 3rd Party Integrations

Once logged in, upgrade your account — a trial account cannot purchase a phone number. The balance you deposit will be used to pay per-message and per-minute fees.

Next, purchase a phone number in your Twilio Console. The number must be enabled for Voice, SMS, and MMS.

Finally, complete your A2P 10DLC Brand and Campaign registration before proceeding. Do not move to the next step until your registration is approved. See the A2P 10DLC section of this guide for details.
 

2. Send Your Twilio Credentials to Cerbo

Once your account is set up and your number is registered, you need to provide Cerbo with the following information:

1. Account SID (Security ID)
2. Authentication Token
3. Your Twilio phone number(s)

Your Account SID and Auth Token can be found on your Twilio Console dashboard.

🔒 Security Note: Do not email these credentials to Cerbo. Instead, paste them into a sticky note on John Doe's chart in Cerbo, then email [e-mail] to let us know they are ready. A support representative will then enable your integration.

3. Configure Webhooks in Twilio

Webhooks allow Twilio to notify Cerbo in real time when calls or messages are received. You need to add three webhooks to each Twilio phone number you will use with Cerbo.

In your Twilio Console, navigate to: Develop tab > Phone Numbers > Manage > Active Numbers, then click on the number you are using with Cerbo.

Add the following three webhook URLs, replacing [yourURL] with your Cerbo URL (e.g., if your Cerbo address is mypractice.md-hq.com, use mypractice):

Incoming calls:

https://[yourURL].md-hq.com/apps/twilio/actions/inbound_call.php

Call status changes:

https://[yourURL].md-hq.com/apps/twilio/actions/finished.php

Incoming messages:

https://[yourURL].md-hq.com/apps/twilio/actions/inbound_sms.php

4. Configure Phone Numbers in Cerbo

Once Cerbo Support confirms your integration is active, navigate to Admin > Manage > Integrations and scroll to the Twilio section. Select Manage Phone Numbers to configure your call and text routing settings (see the Using the Integration section below for details).

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Using the Integration

Configuring Call and Text Routing

After the integration is active, go to Admin > Manage > Integrations and scroll to the Twilio section. Select Manage Phone Numbers and choose the Twilio number you want to configure. A dialog will present the following options:

Outbound Communications

1. Set the number patients see when you call them (can be any verified number).
2. Set the number patients see when you send SMS messages (must be a Twilio number).

Inbound Communications — During Business Hours

1. Set the phone number incoming calls should forward to during business hours.
2. Set the phone number incoming texts should forward to during business hours.

Inbound Communications — Outside Business Hours

1. Set the phone number incoming calls should forward to after hours.
2. Set the phone number incoming texts should forward to after hours.

Additional Settings

1. Voicemail options if the forwarding line is busy or not answered.
2. Business hours definition by day of week (start time, end time, or mark as closed).
3. Notes field for internal reference about the number.

Sending and Receiving Texts and Making Calls

To contact a patient, click on their phone number in the Patient Information block in their chart. A "Make Call or Send Text" dialog will appear with two tabs:
 

Sending a Text

1. Select the patient's number in the "Number to Text" field.
2. Choose the Twilio account to send from.
3. Type your message and click Send Text.

The message sends immediately and is logged in the patient's SMS history in their chart. You can optionally save these settings as your default.
 

Making a Call

1. Select the line you will be calling from ("Your Connection") and the Twilio number to use.
2. Click Place Call.
3. Twilio calls your phone first. Once you pick up, it connects to the patient's number.

The patient sees your Twilio number as the caller ID. You can optionally save these settings as your default.
 

Receiving Texts — Inbound Text Queue

Incoming texts to your Twilio number appear in the "Received Texts" block on your Schedule page. By default, this queue shows messages from the past 7 days. If you need the display window adjusted, contact [e-mail].
 

📝 Patient Phone Number Matching

If an incoming text's number matches a patient's mobile number in their Patient Information block, their name will appear in the queue.

If multiple patients share the same number, the system cannot determine which patient to associate the message with. To resolve this, remove or update the duplicate number from one of the patients' charts.

If a text cannot be matched to any patient, it will appear in your Tasks under Unassigned SMS.

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Troubleshooting & Support

Who to Contact

Issue	Contact
Twilio account setup, login, or billing	Twilio Support — support.twilio.com
A2P 10DLC registration questions, pending status, or rejections	Twilio Support — Cerbo cannot advise on registration
Message delivery failures or carrier filtering	Twilio Support first; Cerbo Support if issue appears platform-related
Webhook configuration in Twilio	Twilio Support or refer to this guide
Cerbo not sending/receiving messages after confirmed integration	Cerbo Support — [e-mail]
Inbound text queue window adjustment	Cerbo Support — [e-mail]
Credential setup / integration activation in Cerbo	Cerbo Support — [e-mail]

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Common Issues

Messages Are Not Being Delivered

1. Confirm your A2P 10DLC Brand and Campaign registrations are approved in your Twilio Console under Messaging > Regulatory Compliance.
2. Confirm your phone number is linked to an approved Messaging Service.
3. Check the Twilio Message Logs in your Console to review error codes for failed messages.
4. If registration is pending or failed, contact Twilio Support — Cerbo cannot intervene.

Texts Not Showing Up in Cerbo

1. Confirm your webhooks are correctly configured in Twilio (see Step 3 in the Setup section above).
2. Confirm the integration is active — you should have received confirmation from Cerbo Support.
3. Contact Cerbo Support at [e-mail] if webhooks are correct and the integration is confirmed active.
    

Incoming Text Not Matched to a Patient

1. Check that the number texting in matches the number recorded in the patient's Patient Information block exactly.
2. If multiple patients share the same number, remove or correct the duplicate — the system cannot auto-resolve this.
3. Unmatched texts appear under Tasks > Unassigned SMS.
    

Registration Rejected or Pending

1. Twilio and The Campaign Registry manage approvals — Cerbo has no access to your registration status.
2. Common rejection reasons include business name/EIN mismatches, incomplete campaign descriptions, or missing opt-in consent language.
3. Contact Twilio Support directly for resolution guidance.

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Scope of Cerbo Support

To ensure expectations are clearly set, the following are outside Cerbo's scope for this integration:

1. Cerbo cannot complete or advise on A2P 10DLC Brand or Campaign registration.
2. Cerbo does not have a direct Twilio support line.
3. Cerbo cannot view, manage, or dispute charges on your Twilio account.
4. Cerbo cannot guarantee message delivery — carrier filtering is outside our control.
5. Cerbo cannot access your Twilio Console, call logs, or account settings.
6. Cerbo cannot resolve registration rejections or pending statuses with Twilio or The Campaign Registry.
7. Call logs are not currently displayed in the patient's chart in the EMR (text message history is).

Cerbo Support is here to help with anything specific to how the integration functions within the Cerbo platform — activation, webhook validation, inbound text queue behavior, and configuration.

Resources

1. Twilio Console: console.twilio.com
2. A2P 10DLC Registration Guide: twilio.com/docs/messaging/compliance/a2p-10dlc/direct-standard-onboarding
3. A2P 10DLC Pricing & Fees: help.twilio.com
4. Twilio Support: support.twilio.com
5. Cerbo Support: [e-mail]

Questions about Cerbo? Contact us at [e-mail]