Smart Claim Selection with Pronto® Evaluates All of a Payer’s Daily Claims Volume to Find Which Claims Have the Highest Savings Probability.
Focused on Your Bottom Line
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.
A reviewer’s daily capacity is a fixed resource. Smart Claim Selection with Pronto® makes it more efficient.
Smart claim selection creates additional capacity to review other types of claims and gain incremental savings.
Specific to Your Needs and Powered by Big Data
Pronto® incorporates profiling of dentist practice patterns into a unique, proprietary and predictive savings analysis with recommendations exclusive to a payer’ s individual culture and corporate philosophy.
Pronto® is powered by DentaBase®, a comprehensive multi-payer claims database that features utilization data on nearly every dentist in the country. The “Big Data” in DentaBase® is the foundation that enables Pronto® to rapidly make ‘intelligent’ choices that are not visible through traditional methods. The resulting analysis enables payers to prioritize which claims require utilization review resources to better optimize internal resources.
Pronto’s Predictive Savings Analysis…
- Ends “pay and chase” with detection of inappropriate claims submission before payment.
- Profiles dentist practice patterns, denial rates and fraud and abuse gaming patterns.
- Features a customizable edit rules structure to adapt to each payer’s requirements.
- Can replace or work within existing claim review processes, depending on your need.
Pronto® — Smart Claim Selection
A flexible platform that enables each payer to customize the rules to optimize incremental savings.
With the statistics and power of Big Data contained in DentaBase®, Pronto® is able to make ‘intelligent’ choices that are not visible to traditional reviewers, enabling you to prioritize where to spend your time and resources to the greatest effect.