Dental procedure trends are on the rise, and with them the possibility of increased fraud, waste and abuse.

Did you know that 75% of dental fraud and abuse alerts are triggered by dentists in just 6 states?*


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

Utilization Management

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

Learn more in the infographic below:

INFOGRAPHIC The Facts: Exploring the Dental Industry Through Informatics - Focus on Fraud, Waste & Abuse

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For more information about our fraud and abuse, predictive analytics and utilization management solutions, please complete the form below.

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* Source: P&R Dental Strategies cross-payer database, DentaBase™ and Fraud & Abuse Detection (FAD) Module. 1/20/2017.

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