Dental Claim Accuracy

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:

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 3% or more on their annual dental spend by using Dental Claim Accuracy to detect improperly coded claims. For example, in 2023, Cotiviti identified and reported more than $52 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 fully accredited by URAC for Health Utilization Management. URAC is the independent leader in promoting healthcare quality and patient safety through renowned accreditation programs. URAC develops its evidence-based standards in collaboration with a wide array of stakeholders and industry experts.