Dental Claim Accuracy

Identify suspect claims early and improve
prepay dental claim integrity

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

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Dental payers continue to face rising challenges as incorrect coding and fraud, waste, and abuse (FWA) drive up costs and undermine program integrity. In 2024, U.S. dental spending reached $189 billion, according to the American Dental Association, with growing claim volume and complexity making improper billing increasingly difficult to detect. As coding combinations grow more complex and billing practices continue to evolve, dental payers need clear visibility into miscoding, inappropriate billing, and emerging risk patterns to protect plan resources, ensure accurate reimbursement, and safeguard member benefits.


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>$64 million

in dental claim savings was identified and reported for one Cotiviti client in a single year

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

Prevent waste, abuse, and errors prepayment while detecting both known and emerging fraud schemes with Cotiviti’s Dental Claim Accuracy solution. Using advanced clinical and coding algorithms applied to national and proprietary edits, the solution flags suspect claims for deeper review. Each flagged claim is evaluated by experienced coding experts, including licensed dentists before final adjudication—delivering fast, efficient results that support timely processing without disrupting provider payments.

With the Cotiviti Dental Claim Accuracy solution, you get:

Accuracy-driven savings

Save an additional 3% of costs—or more—after primary dental claim editing.

Minimized internal workload

Get a full-service approach that reduces client IT and clinical lift.

Reduced abrasion

Avoid incorrect payments upfront through precise prepay claim accuracy.

 

Dental Claim Accuracy solution benefits

Experience the benefits of working with experts who have focused on improving dental claim accuracy for over 20 years.

  • Feel confident with proven results. Across all lines of business and membership sizes, plans typically save 3% or more annually by partnering with Cotiviti to identify improperly coded dental claims or wasteful spending. Cotiviti delivered more than $64 million in annual dental claim savings for a single client.
  • Avoid pay-and-chase. Ensure accuracy and capture savings before payment with our expert prepay review. Certified dental coders and analysts evaluate each flagged claim using clinical documation and member history to ensure claim accuracy.
  • Accelerated outcomes. Most reviewed claims are returned within hours of receipt, enabling fast, efficient processing.
  • Reduce internal resource burden. Rely on a full-service approach to dental claims editing, including ongoing updates to national and proprietary edits, payment guidelines, technology infrastructure, and system configuration—eliminating the need to maintain this expertise in-house.
  • Rely on a licensed and accredited program. Cotiviti’s URAC‑accredited dental claim accuracy solution enables plans to review dental claims for coding accuracy and documentation alignment, supporting recommendations based on applicable coding requirements and plan guidelines. 

Count on Cotiviti expertise for your dental payment integrity

Payment integrity is at the core of what we do. Cotiviti not only identifies suspect dental claims early in the process, but also applies an intensive clinical review to uncover emerging patterns of fraud, waste, and abuse. As part of this evaluation, licensed dentists conduct professional reviews to determine the appropriateness of code combinations across the full spectrum of dental procedures. Our experienced team of coding experts, including licensed dentists, receive ongoing training to stay ahead of evolving industry practices, ensure accurate determinations, and support provider reconsiderations. By doing so, Dental Claim Accuracy extends Cotiviti’s industry-leading payment integrity framework into dental—leveraging the same clinical rigor, analytics infrastructure, and proven methodologies applied across medical and pharmacy programs.


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