P&R Dental Strategies shows new ways dental data and analytics can make an impact and ensure real value in Medicaid dental programs.
Fraud, waste and abuse is a pervasive issue in the healthcare and dental industries whose effects can be felt by nearly every dental payer. Looking at national utilization trends in our multi-payer database, DentaBase®, tells us that all payer organizations are vulnerable to outlier fraud, waste and abuse.
P&R Dental Strategies offers several dental informatics solutions that provide insights needed to detect and eliminate dental fraud, waste and abuse.
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.
Utlization Management the Way You Want It
The P&R Dental Strategies Utilization Management Module (UMM) empowers payers to profile dental providers, identify and prioritize outlier behavior, manage corrective actions and create actionable reports, all from a web-based Software-as-a-Service (SaaS) application powered by DentaBase®, our multi-payer database.
Though there can be legitimate reasons behind unusual utilization patterns, the Utilization Management Module ensures your organization is aware of every instance and is able to take corrective action when necessary.
- Gain greater insight into dentist practices
- Prioritize and address over-utilization by identifying and segmenting behaviors
Manage Your Dental Anti-fraud Initiatives
While waste and abuse are more prevalent in the dental market, outright fraud can be challenging for any payer to address.
P&R Dental Strategies’ Fraud and Abuse Detection (FAD) module provides payers with access to a web-based Software-as-a-Service (SaaS) application offering a highly-targeted means to detect and identify potential fraud, waste, and abuse.
The Fraud and Abuse Detection Module…
- Incorporates predictive modeling and metrics to provide visibility into trends and patterns across payers.
- Delivers alerts that provide an early warning system of suspicious behavior to flag specific outliers.
- Compliments our utilization management solutions.
Trusted, Efficient Active Fraud Protection
Protecting your organization from the impact of fraudulent behavior has traditionally been difficult. Manually watching for signs of fraud can be labor-intensive, costly and prone to missing important infractions.
The Fraud Alert Service (FAS) from P&R Dental Strategies is a quick and simple subscription service that keeps you up to date and aware of any suspicious provider activity.