About The Algorithm
The Local Anesthesia Dangerous Dose algorithm looks at the claim to determine if all the treatments for an individual patient on a single date of service adds up to a toxic dose of local anesthetic as determined by manufacturer’s monograph.
About The Methodology
This algorithm examines all of the procedures performed on a patient in a single visit and calculates the minimum amount of local anesthesia necessary to complete those procedures, taking into account the arch(es) and severity of treatments performed and allowing for possible outliers. Pharmaceutical recommendations are used to determine if that amount would constitute a dangerous dose, calling into question whether all of the procedures could in fact have been performed.
Detect, Prevent and Change Billing Behavior
The Local Anesthesia Dangerous Dose algorithm is one of our Detect and Prevent algorithms, which identifies billing issues with precision at the line level. Payers have the option to receive denial or downcode recommendations on a daily basis in order to avoid paying improper charges, reducing dental spend by up to 5%. Payers also have the option to send messages to providers with billing violations identified, escalating from notification to education to other consequences if issues persist.
MultiPlan’s Dental Payment Integrity algorithms provide extensive business intelligence, helping payers to better understand how their network and other utilized providers are billing. We receive and analyze claims daily, prior to payment, and post the results by billing issue and by provider to a secure portal for direct access and analysis. Payers determine the appropriate action, or can use our integrated pre-payment and behavior change programs.
Reduce dental spend up to 5%. And savings start on day one!
To learn more about MultiPlan’s Dental Payment Integrity Services, contact 800-677-1098 or firstname.lastname@example.org