Nothing hurts a practice's outreach like patients ignoring calls labeled "Spam Likely." A big part of the fix is a caller authentication standard called STIR/SHAKEN. This guide explains what it is, why calls get flagged, and how Aesthetix CRM handles it for you.
Robocalls and caller ID spoofing became a major problem, with tens of billions of robocalls reported in a single year. In response, the FCC created protocols to fight illegal robocalls, and mobile carriers are now required to run caller authentication on the calls they carry.
When a carrier cannot verify that a call really comes from the number it claims, it is more likely to label the call as spam or block it. Calls are also more likely to be flagged when call volume is high, when a number is new, or when recipients report calls as unwanted.
STIR/SHAKEN is a set of protocols that authenticate caller ID and confirm it is legitimate. It uses digital certificates to validate the identity of the caller. Each call is verified against these certificates, and the result is stored so the receiving carrier can trust that the call truly comes from the expected source. The result is a better chance your number shows as verified rather than as suspected spam.
Your phone system runs on Twilio, which Aesthetix CRM fully manages on your behalf. Caller authentication (STIR/SHAKEN), business registration, and caller ID branding are all configured on the Twilio side, not in an in-app screen you manage yourself. You do not need a Twilio login or a separate sign-up.
As part of onboarding and compliance, our team completes your business registration (A2P 10DLC) and the associated caller authentication so your calls are verified where possible. Approval steps on the carrier side can take several days, so we start the process early. For related setup, see the Phone collection.
Keep call volume reasonable and avoid rapid bursts of outbound calls from a single number.
Make sure your business registration is complete. Our team handles this, so reach out if you are unsure of your status.
Ask patients to save your practice number as a contact, which helps their phones treat it as trusted.
If a number becomes heavily flagged despite verification, contact support so we can review options on the carrier side, such as remediation or a fresh number.
Why are my calls showing as "Spam Likely"? Carriers flag calls they cannot verify, along with high-volume or newly active numbers and numbers that recipients report. Caller authentication (STIR/SHAKEN) plus a complete business registration reduces the chance of being flagged.
What is STIR/SHAKEN? It is a caller authentication standard that uses digital certificates to confirm a call really comes from the number it claims. Verified calls are less likely to be labeled as spam.
Do I have to register for STIR/SHAKEN myself? No. Aesthetix CRM manages Twilio for you and completes caller authentication and business registration on the carrier side as part of onboarding. There is no self-service sign-up you need to do.
How long does registration take? Carrier-side approval can take several days, so we begin the process early during onboarding.
My verified number is still getting flagged. What now? Contact support. We can review your registration and call patterns and advise on carrier-side options, including remediation or provisioning a fresh number.
