Dental Claims Advisor

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Software

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.

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Advanceddental claims processing software

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Expedited reimbursement

Process dental claims faster by helping eliminate manual processes, and avoid manual claim suspensions and overpayments by immediately identifying miscoded services.

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Increased payment accuracy

Detect inaccurate coding patterns, miscoded procedures, fraud, waste, and abuse.

Reduced costs

Eliminate the need to manually review each claim for anomalies.

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Promote correct coding behavior

Our dental claims software helps providers receive feedback on incorrect coding patterns to help induce behavioral change.

What’s included

Seamless integration
- 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
Customizable
- 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
Easy-to-understand reports
- 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