Dental Claim Accuracy

Identify suspect claims early and improve pre-pay dental claim integrity

CMS RAC

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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

 

When it comes to verifying codes and sorting through the complexities of plans, providers, and members, count on Cotiviti.

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.

With the Cotiviti Dental Claim Accuracy solution, you get:

1

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.

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.

Dental Claim Accuracy solution benefits

Experience the benefits of working with experts who have focused on improving dental claim accuracy for over 15 years.

  • Feel confident with proven results. No matter the line of business or membership size, plans have the potential to save an average of 2% or more on their annual dental spend by using Dental Claim Accuracy to detect improperly coded claims. For example, in 2021, Cotiviti identified and reported more than $14 million in dental claim savings for one client.
  • Avoid pay-and-chase. Save money up front with our pre-pay dental claim expert review process. Our experienced analysts are certified dental coders and determine the accuracy of a claim by scrutinizing its data and the member’s claim history.
  • Uncover results faster. Results in most cases are delivered within hours after receipt of edited claims.
  • Reduce in-house resource needs. Get a full-service approach to claims editing, with updates to sourced and proprietary editing and payment guidelines, technology infrastructure, and system configurations. Our clients have the peace of mind that resources are being deployed without the hassle of maintaining that expertise in-house.
  • Rely on a licensed and accredited program. Cotiviti’s Dental Claim Accuracy solution is reviewed per guidelines required by state licensing as a Utilization Management Agent and is accredited by the National Committee for Quality Assurance (NCQA) in Utilization Management.”

Count on Cotiviti expertise for your dental payment integrity

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.


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Dental Claim Accuracy is part of Cotiviti’s Payment Accuracy solution suite.

Ready to learn more? Talk to one of our sales representatives—fill out the form below to schedule a call.