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 costly and time-consuming process, this pre-payment analysis is now a viable solution—thanks, in part, to algorithms.
In the simplest of terms, an algorithm is a step-by-step procedure for finding a solution. Our algorithms provide a “recipe” that enables our fully-automated platform to analyze dental claims with precision. And as with any recipe, the algorithms include ingredients (input) to make the finished product (output).
The “ingredients” that go into our algorithms include:
- Clinical knowledge: Our dental experts build algorithms using their own extensive knowledge. They also incorporate guidelines from various professional dental organizations, such as the American Dental Association.
- Dental informatics: Dentistry and technology don’t always speak the same language. Dental informatics is the application of both dental knowledge and information technology, which leads to identifying results with precision and providing context to data.
Within seconds, our algorithms provide a “finished product” that can reduce dental spend by identifying issues, such as:
- Inappropriate procedural charges
- Claims for services that are not biologically possible
- The likelihood of the procedures performed
- Overuse of treatment within a dental specialty
- Excessive or inappropriate referrals
- And more
To learn more about MultiPlan’s algorithms, download our white paper: