Dental Claims Advisor
A SaaS-based customizable, rules-driven payment integrity solution that helps payers and TPAs detect miscoded procedures and flag fraud, waste, abuse, and aberrant claims.
Advanceddental claims processing software
Process dental claims faster by helping eliminate manual processes, and avoid manual claim suspensions and overpayments by immediately identifying miscoded services.
Increased payment accuracy
Detect inaccurate coding patterns, miscoded procedures, fraud, waste, and abuse.
Eliminate the need to manually review each claim for anomalies.
Promote correct coding behavior
Our dental claims software helps providers receive feedback on incorrect coding patterns to help induce behavioral change.
- Delivered in a SaaS model that integrates with payers’ or administrators' claim processing and payment workflow
- All claims can be processed through our rules-based engine, regardless of which clearinghouse(s) you use
- Easy integration with payers’ or administrators' pre- or post-pay claim processing workflow
- Configurable plug-and-play rules for payers and TPAs that validate dental service codes in claims using standardized reimbursement guidelines while accounting for the complexities of authoritative dental coding systems
- Standard aberrancy rules can be augmented with payer-specific rules to address any claim patterns the payer would like to flag for investigation
- Allows payer to turn rules on or off through a portal based on when specific rules are needed
- The results of the claims processed through the Dental Claims Advisor platform are available to the payer through an online portal
- Payers and TPAs have a dashboard for viewing the overall status of processed claims
- Enables payers and TPAs to drill down to understand why certain claims are being flagged for investigation and the charges associated with those claims
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