Dental Data Discussion: Outlier Claim Patterns & Recent Utilization Trends

In one of our recent presentations “Trends in Dental Claims Submission and The Impact on Dental Fraud, Waste and Abuse” we shared major industry and utilization trends that are driving the dental market and what that could mean for payers around the country. We also took a look at real dental claims to show how a payer team can use data and analytics to fight fraud, waste and abuse.

Get the highlights in our new eBook “3 Trends to Watch in Dental Fraud, Waste & Abuse.”  REQUEST EBOOK


Is Your Organization at Risk? Recognizing Fraud, Waste and Abuse

P&R Dental Strategies takes fraud, waste and outlier abuse seriously. Powered by the largest multi-payer dental claims database in the industry, we’ve developed a suite of solutions that enable insurance payers, administrators, brokers and consultants to save time, effort and resources. At the same time, the increased operational efficiencies of our data and analytics help you contain costs.

Some notable trends in utilization and cost that we’ve been tracking:

  • Average Submitted Procedures per Treated Patient have increased year-over-year for the past four years.
  • Average Submitted Charges per Treated Patient have increased year-over-year for the fourth year to $1,029.

Putting Data and Insights to Work

So how can you fight fraud, waste and abuse while maintaining quality of care? Introducing smart claim selection to your review process along with dentist quality measurement are good starting points:

Predictive Analytics with Pronto [icon]

Smart Claim Selection with Pronto® Evaluates All of a Payer’s Daily Claims Volume to Find Which Claims Have the Highest Savings Probability.

Pronto® uses predictive measures to ensure that potentially wasteful or abusive claims and services are selected for review.

  • Predict which claims have the highest probability of savings and should be sent for utilization review.
  • Reduce clutter in your system by eliminating consultant review of claims that are ultimately approved.
  • Improve provider relations by eliminating the “hassle factor” and targeting only those dentists that exhibit outlier behavior.
  • Scale and create additional capacity to review other types of claims and gain incremental savings.


DentaQual Quality Measurement Platform [icon]

DentaQual® provides the first-ever truly objective dentist quality scoring system.

Powering up your member portal with quality score card data and pricing information can help you demonstrate plan value to employers and increase consumer engagement.

Just like they do in the medical industry, employers recognize the need to assist plan members in making better healthcare decisions in dental. Objectively measuring and presenting dental quality score card data in their member portal lets payers be sure they’re being transparent with their members and providing only the best care options in their network.

With outcomes-based measurement, the DentaQual® measurement platform provides a foundation to support payer specific initiatives such as:

  • Pay for Performance
  • Case Management
  • Peer Ranking


Fighting outlier abuse and increasing the quality of your member experience takes data and actionable insights derived from it. We’re here to help get you there. For more information complete the form below.

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