Professional Claim Review (PCR) from P&R Dental Strategies streamlines and lightens a Payer’s administrative load.
A Trusted Leader in Dental Claim Review
Improve your organization’s efficiency in maintaining fraud, waste and abuse objectives with Professional Claim Review
P&R Dental Strategies is the recognized leader in dental claim review with over 20 years of experience perfecting the dental claim review process for payers, third party administrators and self-insured organizations. We offer professional claim review services for all or just a part of your claim workload.
Nationwide, Comprehensive Coverage
Providing coverage across all 50 states including in-state licensure where needed, our team of about 90 highly skilled dentists expertly analyze claims to lighten a payer’s administrative load and ensure you’re not reimbursing for dental services that are not medically necessary or are improperly documented.
Compliance with state utilization review laws and regulations is a fact of life for everyone who works with dental claims. Yet tracking each state’s requirements and investing in systems to maintain compliance can be costly. The alternative of non-compliance is even more costly.
100% Federal and State utilization review compliant program
Our compliance staff has deep domain expertise in state utilization review laws and regulations plus we constantly track updates or alterations in the compliance landscape. The result is a turnkey solution for complete dental claims compliance.
- 100% Federal and state Utilization Review compliant program
- Consultants licensed to review in all States that require Home State Licensure
- URAC Accredited
- Comprehensive reporting capability
- Rigorous quality assurance program for hiring, training and monitoring of consultants
100% Compliance with State Licensing Requirements
Smart Claim Review and Additional Utilization
Professional Claim Review (PCR) can be part of a comprehensive utilization review package that also includes:
Smart Dental Claim Selection and Predictive Analysis with Pronto®
Pronto evaluates all of a payer’s daily claims volume in near real-time to predict which claims have the highest probability of generating savings and should be sent for utilization review. The insight Pronto provides creates additional capacity to review those claims that generate further savings.
- Predict which claims have the highest probability of savings and should be sent for utilization review.
- Reduce clutter in your system by eliminating consultant review of claims that are ultimately approved.
- Improve provider relations by eliminating the “hassle factor” and targeting only those dentists that exhibit outlier behavior.
- Scale and create additional capacity to review other types of claims and gain incremental savings.
Dramatically Improve the Productivity of Your Clinical Review Team with Claim Review Management System (CRMS)
The Claim Review Management System is an application that streamlines the claims review process from end-to-end. Let your clinicians spend time on clinical issues, not administrative issues. Our highly acclaimed Claim Review Management System gives your dental consultants all the tools necessary to complete a claim review including:
- Access to images
- Policy information
- Patient history
- Strict compliance with laws and regulations