Optimize the Delivery of Oral Healthcare

Of the thousands of dental claims submitted to a payer every day for reimbursement, which ones should be reviewed for a medical necessity? How can payers determine which claims should be held for review prior to payment in an accurate and efficient manner? The answer is Pronto™ a dental utilization review solution from P&R Dental Strategies.

Pronto™ is the convergence of a cross-payer database with analytics and clinical input. Pronto’s sophisticated analytics engine evaluates all of a payer’s daily claims volume in near real-time and predicts which claims have the highest probability of delivering savings for the payer and which should be sent for utilization review.

Pronto™ incorporates profiling of provider practice patterns into a unique, proprietary predictive savings analysis that determines the relative likelihood that a claim will result in savings if reviewed and delivers the insights needed by payers to partner with providers and address unnecessary services. Pronto™:

• Ends “pay and chase” with detection of inapproriate claims submission before payment
• Works within existing claim review processes
• Profiles provider practice patterns, denial rates and fraud and abuse gaming patterns
• Customizable rules structure

See how Smart Claim Selection can make a difference in provider abuse trends and return savings to your bottom line.

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