The Problem: Dental Fraud
With potential losses approaching $13 billion annually, dental fraud, waste and abuse (FWA) is emerging as a significant challenge for dental plans. Dental FWA affects the entire care delivery system, including payers, providers and patients. A problem of this magnitude requires a coordinated approach which leverages the best data assets, analytic models, technology and expertise the industry has to offer. With Verisk Health and DCI, you can ensure your organization accurately and promptly pays all dental claims.
The Solution: DentalClaim Insight
Features
- Pre-payment SaaS solution with user-friendly interface
- Highly customizable claims editing and flagging logic
- Profile and score high-risk providers and claims
- Professional claim review by AADC-certified dentists
- Dental claim pre-authorization and analysis
- Each claim is processed against complete patient history
Benefits
- Improves dental claims payment accuracy
- Reduces Per Member Per Month (PMPM) costs
- Stops fraud, waste and abuse before claims are paid
- Identifies and proactively address high-risk activity
- Achieves total dental cost containment in a single solution
Next Steps
DentalClaim Insight
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