Skip to main content

Dental claim review expertise nets significant savings with minimal abrasion for large dental payer

Learn how one payer partners with Cotiviti to augment the capabilities of its own dental reviewers and internal claim editing system with prepay, post-adjudication dental claims review.

Download PDF

Reviewing dental claims for clinical and coding appropriateness before payment requires extensive in-house resources for dental plans, especially as the American Dental Association (ADA) adds or eliminates CDT codes each year. For one national dental payer with more than 6 million members across commercial, Medicare, and self-insured lines of business, turning to an outside partner to assist with dental claims review and reducing fraud, waste, and abuse has yielded significant savings.

Read our Savings Spotlight and learn how the payer achieved:

  • Increased prepay savings by avoiding improper claims payment
  • Reduced cost and effort of postpay audit and recovery
  • Lowered appeals rate
  • Improved compliance with CMS regulations, state Utilization Management regulations, and ADA guidelines
  • Reduced dental provider abrasion