Actionable business intelligence and quality assessment solutions from P&R Dental Strategies, the premier dental insights company.
Smart Claim Selection with Pronto® Evaluates All of a Payer’s Daily Claims Volume to Find Which Claims Have the Highest Savings Probability.
Pronto® evaluates all of a payer’s daily claims volume in near real-time to predict which claims have the highest probability of generating savings and should be sent for utilization review. The insight Pronto® provides creates additional capacity to review those claims that generate further savings.
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.
Pronto’s Predictive Savings Analysis…
- Ends “pay and chase” with detection of inappropriate claims submission before payment.
- Profiles dentist practice patterns, denial rates and fraud and abuse gaming patterns.
- Features a customizable edit rules structure to adapt to each payer’s requirements.
- Can replace or work within existing claim review processes, depending on your need.
DentaQual® Is An Objective Measurement Platform Designed with the Needs of Payers and Employers in Mind
Providing consumers with more content to make better buying decisions is a common trend in many industries. The dental industry is no exception: employers are recognizing the need to assist plan members to make better healthcare decisions in dental like they can in medical.
Employers are increasingly demanding that dental insurance payers provide the tools and content to enable consumers to make better health care decisions by providing quality scores on individual dentists. DentaQual® meets those demands with an objective, peer-to-peer and claims-based dentist quality measurement platform.
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
