We are excited to introduce Analytics in Action, our P&R Dental Strategies blog, which we hope will become a source of information and reference for anyone interested in oral health and the application of analytics to solve dental industry business challenges. Check back frequently for updates and resources, as well as product announcements and opportunities to connect with us at conferences and events throughout the year.
September 14, 2022
Evolving utilization review processes to the next level requires harnessing the power of both predictive analytics and artificial intelligence image review technology.
Interest in the use of artificial intelligence technology in the dental industry has been growing steadily, with many practices considering the use of A.I. for additional clinical support. A.I. can streamline processes and enhance workflow and see things even a trained eye can miss. A.I. has even been successfully used to diagnose patients, with experts noting that it has the potential to reduce provider fatigue and diagnostic errors.
Outside of the dental office, payers are beginning to glimpse the potential for improving the claim selection process with the use of A.I. technology and machine learning (ML).
As many payers discover when piloting A.I. technology in their utilization review process, obtaining X-rays and other images to support a robust A.I.-powered image analysis process poses several unique challenges including:
It is possible to overcome these challenges and the growing expense that comes with them, however. When artificial intelligence image review technology is combined with an algorithmically-driven, predictive analytics engine that does not rely on processing images to determine which claims should be reviewed, real efficiency and flexibility are unlocked. This synergistic combination of image-independent predictive analytics and A.I. image technology allows dental payers to experience the future of managing a utilization review workflow: smart selection of which claims to review.
An inefficient dental claim review workflow can eat up internal resources, introduce delays and create backlogs. Reviewing every claim or auto-adjudicating every claim — extreme opposite ends of the review philosophy spectrum — only compounds issues and costs. One solution is for payers to utilize a pre-payment predictive analytics engine in their claim review process. With advanced algorithms, pattern recognition tools and a sufficiently large database of procedure records from multiple payers to analyze, such a “smart claim selection” platform would work with or without x-rays and be able to predict, in real time, which dental claims are most likely to result in a denial due to insufficient medical necessity or inappropriate billing practices. This approach has many potential benefits:
On its own, a predictive analytics engine is an extremely powerful tool to enhance the efficiency of the utilization review process. However, by combining it with A.I. image analysis technology, a true “smart claim selection” workflow can be attained. Here are three key components of a complete smart claim selection plan:
The third component of this “three-legged stool” is critical. A licensed dentist is still required in the process if a claim is to be denied or partially denied: payers must still retain dental consultants on staff, or outsource their claim review. The human, dental consultant element is also an added benefit when they are used to support calibration of the system and A.I./machine learning processes.
From diagnostic assistance to streamlining the patient check-in process, A.I. is beginning to revolutionize the oral healthcare industry. Experts agree that embracing digital workflows and the increase of digitalization can not only improve the doctor-patient relationship, with providers able to spend more time communicating with patients rather than being bogged down by back-office administrative tasks, but it can also lead to more evidence-based decisions. Likewise, dental insurers also stand to benefit greatly in efficiency and cost savings by implementing A.I. technology into their utilization review processes — either by taking the time to develop the technology themselves or by choosing a trusted partner with the data, a legacy of utilization review expertise and smart claim selection platform to do it for them.
To learn more about how optimize dental utilization review efficiency by combining predictive analytics, artificial intelligence image technology and the expertise of dental consultants, contact P&R Dental Strategies today.