Insights to Discover and Manage Outlier Abuse in Your Network

The Utilization Management Module™ (UMM) puts Big Data and deep clinical expertise into your hands to help analyze, manage and control your in-network provider utilization.

With over 200 ratios for outlier measurement, the UMM empowers payers to profile individual dental providers and identify upcoding, unbundling and overutilzition behavior, all from a web-based Software-as-a-Service (SaaS) application.

Put Big Data to Work.

The Utilization Management Module draws on the power of DentaBase®, our vast, multi-payer dental claims database containing data on over 200,000 active U.S. dentists and billions of dental claim records. With the UMM, profile dental providers, identify outlier behavior, manage corrective actions and create actionable reports – all in your browser.


5 Ways to Optimize Your Dental Utilization Management Operations
What you get with a Utilization Management Module subscription

Expert insights icon

NEW COVID-19 Active Indicator:
See which dentists are actively practicing since April 1st, 2020 at each access point with a simple Yes/No flag.

Last Date of Service icon

NEW Date Stamp:
Last Date of Service Indicator displays each provider’s most current visible date of service.

Provider Report Cards icon

Provider Report Cards,
that can be shared with providers, showing outliers and powered by the most comprehensive dental provider data available

Outlier Abuse icon

Address over-utilization, upcoding and unbundling by identifying and segmenting provider behavior.

Corrective Education icon

Target providers in need of corrective education or action before costly problems arise.


Powerful Provider Profiling.

Utilization Management Module now with COVID-19 Active Indicator - who's open and actively practicing

The Utilization Management Module: Search-it-yourself, all in-browser.

The UMM evaluates submitted claims data across more than 200 standard ratios to calculate an abuse score for every dentist that is 1) Based on normative clinical ratios, 2) Focused on abuse (upcoding, unbundling and over-utilization), 3) Reflects standards of care (specialty, geography).

With this insight, the UMM empowers payers to take charge of their utilization management and provider intervention using advanced tools that keep you informed. The UMM gives dental provider intervention teams all the information they need to take an active role and have effective discussions with dentists.


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With the global pandemic shutdown and reopening of the dental market, change will be the norm for the forseeable future. Understanding changing provider behavior and ensuring your operations are running at peak efficiency is critical for long-term success in this unpredictable dental market.

Whether you’re adjusting your utilization review procedures to meet new needs or just looking to have a reliable source of data on who’s actively practicing and how – the unique UMM tool empowers payer teams to increase efficiency, control costs and get back to business.

Extensive search, filter and segmentation capabilities to manage outlier abuse in your network.

Manage Risk
Robust search tools tap into the power of DentaBase to deliver detailed profile insights on dentists, including a risk assessment tool and abuse rating.

Robust search tools in the UMM

Where Is Outlier Behavior Focused?
See the number of outlier ratios each dentist has triggered in Unbundling, Upcoding and Over-utilization. You decide what actions to take.


Utilization detail in the UMM

Provider Affiliations and Abuse Scores
For each DSO/group practice, the UMM delivers an Overall Abuse Score, along with the practice-level ratio detail for outlier behavior. Dentists associated with the group practice are listed and outlier detail is available for each.

Affiliation search results in the UMM
 

Take an active role in improving your utilization management. The extensive data and expertise of P&R Dental Strategies will get you there. For more information on the Utilization Management Module, please complete the form below.