Identify suspect claims early and improve pre-pay dental claim integrity
Discover more in payment integrity
Financial losses due to fraud, waste, and abuse (FWA) are a major challenge for dental plans. According to the National Health Care Anti-Fraud Association (NHCAA), an estimated $12.5 billion of the $250 billion spent on dental care nationwide is lost to dental fraud, waste, and abuse every year.
>$14 million
in dental claim savings was identified and reported for one Cotiviti client in 2021
Prevent waste, abuse and errors prepay and detect known and unknown schemes of fraud and abuse patterns earlier with Cotiviti’s prepay Dental Claim Accuracy solution. This solution applies advanced clinical and coding algorithms to nationally sourced edits, flagging suspect claims. The suspicious claims are then reviewed by teams of analysts, coding experts, and consultants before final adjudication. And results are fast—in most cases, we render payment recommendations within hours.
Significant savings
Save an additional 2% of costs—or more—after primary dental claim editing.
Low IT burden
Get a managed service that reduces client IT and clinical lift.
Reduced abrasion
Prevent incorrect payments from being made in the first place with our pre-pay accuracy.
Save an additional 2% of costs—or more—after primary dental claim editing.
Get a managed service that reduces client IT and clinical lift.
Prevent incorrect payments from being made in the first place with our pre-pay accuracy.
Experience the benefits of working with experts who have focused on improving dental claim accuracy for over 15 years.
Payment integrity is our focus. Not only do we flag claims up front, but we offer an intensive screening process to determine patterns of FWA. As part of this process, we consult experienced dentists for professional review of claims, providing a determination of necessity as well as appropriateness of the code combinations. Our dentist consultants are licensed and experienced in reviewing claims covering a complete range of procedures. They are also trained regularly to stay ahead of market changes, make accurate determinations, and support provider reconsiderations.
Dental Claim Accuracy is part of Cotiviti’s Payment Accuracy solution suite.