Dental AI Helps Providers Correct Incomplete Insurance Claims Prior to Payer Review
ANN ARBOR, Mich.–(BUSINESS WIRE)–#AIforDental—NovoDynamics, Inc., the industry-leading artificial intelligence (AI) solutions provider for the Dental industry, today announced commercial deployment of the latest release of NovoHealth Dental. While automatically performing real-time utilization review, NovoHealth Dental pre-checks insurance claim submissions to determine whether all required documentation is attached — including x-ray images, charts, and correspondence — based on payer-specific guidelines for each dental procedure code. Now, the NovoHealth Dental Claim Quality Assurance module also verifies that the anatomy referenced by the claim is clearly visible in attached images. If the claim submission is incomplete, NovoHealth Dental immediately triggers an alert to request the missing documentation from the dental office.
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NovoHealth Dental has automatically analyzed claim data for dozens of major U.S. dental insurers and found up to 78% of paid claims lacked required documentation.
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“NovoHealth Dental’s pre-emptive claim quality and verification approach saves both payers and providers significant time, effort, and costs,” says NovoDynamics Dental Director Joseph Borg, DDS. “And, by adding intelligent automation early in the claim submission workflow, NovoHealth Dental Claim Quality Assurance also brings greater consistency and transparency to the system, making it easier for dentists and their patients to know when their claims qualify for payment.”
Historically, payer staff has had to determine whether claim attachments include the images required for clinical review, and clinicians can typically only examine 1 to 2% of the enormous submission volume. Many incomplete claims slip through and either get paid or hold up the review process. As a result, both payers and providers can suffer excess costs and delays, and from the provider’s perspective, payers seem to inconsistently pay, pend, or deny their claims.
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NovoDynamics Dental AI solution scrutinizes every incoming submission in real time and appropriately routes claims through the payer’s workflow.
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NovoHealth Dental Claim Quality Assurance automatically:
- Recognizes and classifies attachment types, distinguishing between radiographs (x-ray images), photographs, charts, and correspondence.
- Separates individual views from full-mouth series and specifies each image as bitewing, periapical, or panoramic.
- Identifies and labels quadrants and teeth and ascertains if the necessary anatomy is visible.
- Determines if evidence required by the payer for the specific procedure is included.
- Notifies the submitting dental office of unfulfilled claim requirements.
About NovoHealth Dental
In addition to determining whether each claim submission is complete, NovoHealth Dental automatically performs clinical analyses that evaluate whether the evidence provided qualifies the claim for payment, based on the insurer’s criteria. Plus, NovoHealth Dental reliably uncovers potentially suspect submissions. When a claim meets the payer’s standards, it can be routed for auto-adjudication. If NovoHealth Dental spots any concerns that might warrant denial, it annotates, flags, prioritizes, and automatically routes the claim for clinician review. Results include:
- Greater review productivity, consistency, and cost savings for payers.
- Faster, more accurate, more predictable claim decisions for providers and their patients.
About NovoDynamics, Inc.
NovoDynamics provides artificial intelligence (AI) solutions that address critical healthcare challenges, save payers and providers time and money, and help improve quality of care for patients. NovoDynamics, an In-Q-Tel portfolio company, has been applying its proven AI expertise and advanced image processing technology to solve complex problems for governments, commercial enterprises, and academic institutions since 2001. For more information, follow NovoDynamics on LinkedIn and Twitter (@NovoDynamics), or visit NovoDynamics.com.
Contacts
MEDIA RELATIONS:
Catherine Irwin
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