Utilization Management Module™

P&R Dental Strategies convened a panel of dental experts from a variety of payers that direct utilization management programs at their respective companies to help design a web-based  application to mine the vast claims data in DentaBase® to improve utilization. The end result is the Utilization Management Module™ (UMM), a DentSource™ solution which enables users to identify the dentists in their network that are outliers on specific utilization patterns and calculate the financial impact of that behavior.    

The UMM users can analyze their network’s utilization patterns to identify potential overutilization, upcoding and unbundling by individual dentists. Individual provider-level analytics incorporate more than 200 ratios measuring utilization on procedure-to-procedure, procedure-to-patient with large sample sizes derived from DentaBase. Outlier behaviors are determined based on a standard deviation from the mean for each ratio, comparing peers (by specialty) to one another in their geographic region.