Defending Your Dental Plans from Fraud, Waste, and Abuse
Constant Vigilance
Dental FWA is on the rise. There are actually training programs for dentists on how to maximize their reimbursement through multiple billings, such as billing the Medical and Dental plan for the same service. Dental FWA costs as much as $12.5 billion each year, and your plan could be at risk.
Context4 Dental Payment Integrity is an integrated, modular solution within the Context4 Health Plans Suite. Built with the help of our dental benefits experts, it contains a full array of rules, analytics, and data extracts designed to safeguard your dental plans.
Analysis that Empowers Your Organization
Context4 Dental Payment Integrity combines a deep library of pre-built rules with an array of pre-built analytics and user-driven data extracts. All of this helps you to identify potential FWA situations affecting your dental plan today, and analyze the data needed to investigate those cases.
You’ll be made aware of potentially fraudulent claims before you pay, increasing the efficiency of your operations and lowering costs. Rapid isolation of FWA is not just important for your bottom line, but for the health and welfare of plan members.
The Power of Dental Payment Integrity
Gain visibility into suspicious billing and treatment practices at the provider level using our sophisticated rules engine and thousands of pre-built rules.
Use our pre-built analytics to identify provider aberrant utilization patterns within your entire health plan.
Analyze across all professional and facility claims within all coverage types, so no part of your health plan goes unguarded.
Receive actionable insight into the problems identified with options for resolution.
Use our user-driven data extracts to prepare information needed for case investigations.
Without prompt and efficient detection, your plan could be prey to today’s most adaptive and insidious FWA themes.
Want to know the real state of your Dental Payment Integrity? Send us your post-adjudicated claims for a test run. You will be surprised at the results.
