DentaLens

10/16/2020

This patient recently called his dentist’s office because of a small chip on one of his teeth. Over the phone, the person setting the appointment told him it would probably need a crown. Sight unseen, and not even a clinician. Due to decreased patient volume related to COVID-19, it’s possible some dental practices will push to perform more extensive (and expensive) procedures even if they may not be necessary. It’s more important now, more than ever, to be on the lookout for over-treatment and upcoding.

09/21/2020

Tomorrow kicks off the National Association of Dental Plans CONVERGE 2020 and for the first time ever it is a virtual event. We are proud to be a Gold Sponsor again this year and look forward to all of the exciting sessions they have lined up. To learn more or register, visit nadpconverge.org. See you there!

09/16/2020

MultiPlan’s Dental Payment Integrity services rely on clinical knowledge, informatics and forensics to analyze dental claims all while considering the context of the claim. Learn how our algorithms work to detect and prevent inappropriate billing with a comprehensive approach > https://www.multiplan.us/multiplan-dental-payment-integrity-periodontal-scaling-and-root-planing-upcode-algorithm/

Learn how a dental payor can use Dental Payment Integrity to identify appropriate billing easily with algorithms. Read now >

09/09/2020

MultiPlan's Dental Payment Integrity algorithms are automated to find improper billing dental charges for our dental payors - before payment is made. Learn more about how our impossible age algorithm is one of many that can work to detect and prevent billing errors that might have otherwise been missed > https://www.multiplan.us/impossible-age-algorithm/

About The Algorithm The Impossible Age algorithm compares the age of the patient at the time of the procedure with the age constraint specified by generally accepted age thresholds or an age constraint dictated by biology or treatment. About The Methodology The Impossible Age algorithm analyzes ever...

08/05/2020

This patient recently called his dentist’s office because of a small chip on one of his teeth. Over the phone, the person setting the appointment told him it would probably need a crown. Sight unseen, and not even a clinician. Due to decreased patient volume related to COVID-19, it’s possible some dental practices will push to perform more extensive (and expensive) procedures even if they may not be necessary. It’s more important now, more than ever, to be on the lookout for over-treatment and upcoding.

07/22/2020

This dental provider bills for surgical tooth extractions far more frequently than other providers with the same specialty. By analyzing a large sampling of claims from similar dental providers, MultiPlan made sure this outlier did not go unnoticed. Our Dental Payment Integrity Services helped the payer to identify the billing issue. Now they can use our integrated behavior change service or otherwise work with the provider to ensure they don’t bill for surgical extractions when a simple extraction was performed. Learn more > https://www.multiplan.us/services/dental-payment-integrity/

07/02/2020

This patient has just started grade school and enjoys art and playing soccer. She’s just gotten her first molar, but after a routine appointment the dentist billed for extraction of a wisdom tooth. MultiPlan’s Dental Payment Integrity Services flagged this impossibility. In fact we look at every CDT code billed on every claim to gauge the appropriateness of the service for the patient’s age. This way, payers don’t pay for a service that isn’t possible.

06/17/2020

For most dental payers, chasing overpaid claims is not cost-effective or practical. Plus, this post-payment approach often results in lost dollars. MultiPlan takes a different approach. Our Dental Payment Integrity services identify billing inaccuracies before claims get paid. Once considered a cost...

06/05/2020

MultiPlan offers the first and only pre-payment bill review service that enables dental payers to finally make a real impact by detecting improper billing, including pointing out areas of potential waste, abuse and fraud. Fully-automated, our service makes it possible to identify improper charges on large and small dollar claims before the claim is paid. Stop overlooking high-volume claims analysis and start eliminating manual “pay and chase” reviews.

05/27/2020

This dental provider bills for surgical tooth extractions far more frequently than other providers with the same specialty. By analyzing a large sampling of claims from similar dental providers, made sure this outlier did not go unnoticed. Our Dental Payment Integrity Services helped the payer to identify the billing issue. Now they can use our integrated behavior change service or otherwise work with the provider to ensure they don’t bill for surgical extractions when a simple extraction was performed.

05/13/2020

This patient has just started grade school and enjoys art and playing soccer. She’s just gotten her first molar, but after a routine appointment the dentist billed for extraction of a wisdom tooth. MultiPlan’s Dental Payment Integrity Services flagged this impossibility. In fact we look at every CDT code billed on every claim to gauge the appropriateness of the service for the patient’s age. This way, payers don’t pay for a service that isn’t possible.
https://www.multiplan.us/services/dental-payment-integrity/

04/23/2020

The claims submitted for a single patient stated that 14 dental procedures were administered during a single visit. The level of local anesthesia administered in order to complete these procedures would have been considerably higher than what the manufacturers recommend. MultiPlan’s Dental Payment Integrity Services were able to determine that the procedures, as billed, were likely not all performed on this patient. https://www.multiplan.us/services/dental-payment-integrity/