Fraud and Abuse Detection Module™

P&R Dental Strategies convened a panel of dental industry fraud and abuse experts from a variety of payers to help design a web-based application to mine the vast claims data in DentaBase® to support the business needs of dental fraud and abuse investigators. The end result is the Fraud and Abuse Detection Module™ (FAD), a solution that identifies unusual patterns of claims behavior that warrant further investigation.

FAD contains detailed provider profiles on specific metrics that are compared to regional benchmarks to assist in the identification of potentially fraudulent or abusive behavior by providers. Alerts indicate suspected outlier behaviors that do not appear to be consistent with the common practice of their peers. Rather than waiting to receive complaints from regulators, FAD now gives your dental fraud investigators the ability to act proactively as opposed to reactively.

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.

If you prefer a turnkey approach to outlier abuse management, consider our DentAlert™ watchdog service to notify you of suspicious activity in your network.

Find out how insights from the predictive modeling and metrics of P&R Dental Strategies’ solutions can help dental insurance payers and self-insured employers detect fraud and abuse.

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