Dental claim review expertise supports significant savings with minimal abrasion for large dental payer

Accurately reviewing dental claims for clinical and coding appropriateness is a growing challenge for dental plans, particularly as the American Dental Association (ADA) updates CDT codes each year. For one national dental payer with more than 7 million members across commercial, Medicare, and self-insured lines of business, supplementing internal resources with a specialized dental claim review partner proved to be a strategic move, helping to reduce exposure to fraud, waste, and abuse while supporting significant cost savings, reduced administrative burden, and reduced provider abrasion.

A Cotiviti Dental Claim Accuracy client since 2007, the payer partners with Cotiviti to augment its internal dental claim review team and claim editing system with both prepay and post-adjudication dental claims review support. As one of the nation’s largest Medicare Advantage payers, timely claim turnaround has been an important factor in supporting the plan’s quality rating objectives and regulatory compliance efforts. Cotiviti’s URAC‑accredited Dental Claim Accuracy solution enables plans to review dental claims for coding accuracy and documentation alignment, supporting recommendations based on applicable coding requirements and plan guidelines.

Key results*

Key benefits

• Increased prepay savings by helping avoid improper claims payment
• Reduced cost and effort associated with postpay audit and recovery
• Lowered appeals rate observed over engagement period
• Reduced dental provider abrasion

Key Cotiviti differentiators

• Demonstrated incremental cost savings
• Support for increased payment accuracy
• Deep subject matter expertise
• Strong understanding of business needs
• Accelerated time-to-value

*The results depicted are based on an individual client’s experiences and circumstances. Results may vary depending on factors including but not limited to usage and application.