Hear us at the 2017 National Medicaid Symposium
At the June 4-6 2017 National Medicaid, Medicare, and CHIP Oral Health Symposium, P&R Dental Strategies Chief Operating Officer, Tyrette Hamilton, will be presenting on the role of utilization management in program integrity to reduce fraud, waste, and abuse. Dental informatics provide insights to help contain costs and insure there is greater quality of care for program enrollees.
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.