Two Benchmarking Reports, A Suite of Efficiency Solutions.
The Utilization Management Optimization Report — Benchmark Your UM Practices
Improve your organization’s understanding of its utilization management practices with this competitive landscape report. Delivering a comprehensive review of UM practices, see where your organization stands when it comes to:
- Traditional claims processing/edit practices
- Benefit design norms
- Utilization review criteria best practices
1. Assess clinical criteria and guidelines
2. Evaluate edit/processor effectiveness
3. Reduce/mitigate the impact of outlier behavior
Evaluate Every Facet of Your Utilization Management
The Utilization Management Optimization Report is an extensive look at your organization’s operations that ensures no part of your utilization management processes is left unexamined. Each delivered workbook provides procedure code-level evaluation of:
- Benefit classification
- Contract limitations, exclusions and frequency limits
- Anonymized competitive comparisons
- Recommended standard adjudication system edits/processor rules
- Percentage of clinical recommendations for denial and/or alternate benefit coding
- Standard documentation requirements for clinical review (where applicable) and comparison of clinical review guidelines/criteria
The Market Optimization Report — How Do You Stack Up?
Take a deep dive into how your products stack up against the competition with this “diagnostic exam.” You’ll see how you’re performing relative to a de-identified group of other payers from a cost and utilization standpoint. All information is drawn from DentaBase®, the most extensive dental database in the U.S. Be sure that you are always being compared against the most accurate and complete data.
- See de-identified real examples of competitive offerings in your state.
- Gain insight on differences in claims costs for in-network services vs. a de-identified group of competitors, organized by specific procedure code.
Why is my cost per Patient so high? Is my Price per Treatment typical?
Answers to questions like these are simple to answer using real-world data and the guidance found in the Market Optimization Report. The Market Optimization Report provides:
- Both in-network and out-of-network performance metrics
- State level analysis of Price per Treatment (Price), Treatments per Patient (Utilization) & Cost per Patient (Cost)
- Geographic implications (e.g., statewide, regional, etc.)
- Adult claim costs compared to Children claims costs
- And more…
You Know You Need to Optimize. What Are the Next Steps?
Put newly discovered utilization management and market optimization insights into action. Our suite of data-driven solutions can help you take the next steps to inform strategy and contain costs.
Streamline and Lighten Your Administrative Load: Professional Claim Review (PCR)
Let the recognized national market leader in dental claim review take care of your claim review process, freeing up your budget and workforce to focus on other priorities. Providing coverage across all 50 states, our team of 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 improperly documented.
- 100% Federal and state Utilization Review compliance
- Consultants in all states that require Home State Licensure
- URAC Accredited
- Comprehensive reporting capability
- Rigorous quality assurance program for hiring, training and monitoring of consultants
Smart Dental Claim Selection for Incremental Savings: 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.
Utilization Management the Way You Want It: The Utilization Management Module (UMM)
Profile dental providers, identify and prioritize outlier behavior, manage corrective actions and create actionable reports, all from a web application powered by DentaBase®, our multi-payer database.
- Gain greater insight into dentist practices
- Prioritize and address over-utilization by identifying and segmenting behaviors
- Target providers in need of corrective education or action
- Access a provider report card showing a dentist’s behavior by procedure code and with risk assessment insights
Comprehensive Network Management: The Network Development Module (NDM)
The Network Development Module (NDM) is a self-service, web-based tool that empowers payers to identify the best dentists to include in their network. With deep insights based on our extensive, multi-payer database, DentaBase®, payers can use the NDM to:
- Increase the range of potential recruits and network prospects.
- Help manage a network with preferred capabilities and discounts.
- Segment a dentist population by financial risk.
- Gain insights on individual dentist fees to build a network that meets your needs.
Or, if you’re looking for a turnkey, subscription-based network accuracy solution, try our Network Directory Accuracy Service.
