Get big insights into outlier behavior to optimize operations and contain costs.
Procedure trends are on the rise and with them comes the possibility of increased fraud, waste and abuse. The challenge is knowing where and how to look for abuse patterns. Insights from our multi-payer database and dental informatics services can help payers connect the dots to identify fraud, waste and abuse so each can be addressed before payment.
P&R Dental Strategies has three solutions that form the basis of an effective fraud, waste and abuse strategy:
Predictive Analytics with Pronto®
Pronto® is a data analytics solution powered by DentaBase®, P&R Dental Strategies’ extensive multi-payer claims database. Pronto’s sophisticated analytics engine evaluates all of a payer’s daily claims volume in near real-time, predicts which claims have the highest probability of delivering savings for the payer and which should be sent for utilization review.
Pronto’s Predictive Savings Analysis…
- Automatically rank-orders and tags claims before payment, ending “pay and chase.”
- Sends flagged claims for the dental consultants’ professional claims review, thereby maximizing ROI.
- Offers a customizable rules structure based on the clinical and strategic objectives of the payer.
- Can replace or work with an existing claims selection process, depending on the payer’s need
- Delivers the insights needed by payers to partner with providers and address unnecessary services
With P&R Dental Strategies’ utilization management solutions, payers have the tools to profile dental providers, identify and prioritize outlier behavior, manage corrective actions and create actionable reports.
- Provide payers with greater insight into dentist practices
- Allow payers to prioritize and address over-utilization by identifying and segmenting behaviors
Fraud and Abuse Detection
With P&R Dental Strategies’ fraud and abuse detection solutions, payers have a highly targeted means to detect and identify potential fraud, waste, and abuse.
- Provides visibility into trends and patterns across payers
- Alerts provide an early warning system of suspicious behavior and flag specific outliers.
- Complements our utilization management solutions