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PAYMENT INTEGRITY

Savings spotlight: Dental claim review expertise nets significant savings

Dental claims are slightly different than other healthcare claims, and prepay review for clinical and coding accuracy takes extensive in-house resources for dental plans. Add to that the ever-changing CDT codes from the American Dental Association (ADA) each year and it quickly becomes clear that dental claims require targeted expertise to pay correctly. In addition, just like health plans, dental plans are also currently dealing with fallout from pent-up demand that accumulated during the height of the COVID-19 pandemic and beyond.

One major dental payer has successfully navigated these challenges with Cotiviti’s Dental Claim Accuracy solution. In our recent case study, learn this payer yielded significant savings by working with Cotiviti to assist with dental claim reviews and reduce waste and abuse. 

See how the plan achieved: 

  • Increased prepay savings by avoiding improper claims payment
  • Reduced cost and effort of postpay audit and recovery
  • Improved compliance with CMS regulations, ADA guidelines, and more
  • A low annual appeals rate 

See how you can improve dental claim accuracy while improving outcomes for members and dental providers.

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WRITTEN BY

Steven M. Canfield, D.D.S.
Dr. Canfield works with Cotiviti’s prepayment leadership team and has been responsible for Dental Claim Accuracy operations since 2012, including overseeing a panel of professional consultants that perform clinical claim reviews. He also works as a clinical instructor at the University of Utah School of Dentistry and operates a private practice out of Salt Lake City, Utah. Dr. Canfield attended dental school at Creighton University, and has been practicing dentistry and reviewing dental insurance claims for more than 30 years.

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PAYMENT INTEGRITY

Savings spotlight: Dental claim review expertise nets significant savings

Steven M. Canfield, D.D.S.

Sep 13, 2023

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