Did you know that 75% of dental fraud and abuse alerts are triggered by dentists in just 6 states?1
Three quarters of the fraud and abuse alerts triggered in the P&R Dental Strategies Fraud and Abuse Detection (FAD) solution came from dentists in California, Texas, New York, Arizona, New Jersey and Florida. 90% of alerts came from 16 states. Insights like these from our cross-payer database and informatics services can help payers connect the dots to identify fraud, waste and abuse and address each 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 cross-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
For more information about our fraud and abuse, predictive analytics and
utilization management solutions, please complete the form below.
1 P&R Dental Strategies cross-payer database, DentaBase™ and Fraud & Abuse Detection (FAD) Module. 1/20/2017.