NADP Knowledge Center
*FREE* How dental plans can move beyond standard claim editing to increase pre-pay claim accuracy (recording)
Recorded On: 11/19/2020
Financial losses due to fraud, waste, and abuse (FWA) are a significant challenge for dental plans. According to the National Health Care Anti-Fraud Association, an estimated $12.5 billion is lost every year to dental FWA. Dental plans put a lot of time and effort into rooting out fraud and abuse on the backend, but they often lack the time and resources to fully address the high-volume of waste in a prepay model. Meanwhile, the American Dental Association (ADA) continues to add and eliminate CDT codes every year, creating complexity for plans, providers, and members and often resulting in incorrect coding of procedures. In certain cases, providers make educated guesses when determining which code to use or even add codes simply hoping to receive payment. In this session, two Cotiviti dental specialists will explore how dental payers can go beyond standard eligibility checks and simple claim code edits to shore up their pre-pay programs without disrupting claim flow or contributing to provider abrasion.
In this session you’ll learn:
- How to address the four main problem areas in payment that dental plans often overlook
- How to add expert pre-pay claim review to all claims, saving meaningful dollars without adding additional resources or slowing down processes
- How to best link prior authorization review with pre-pay claim review
This webinar is sponsored by:
Steve Canfield, DDS, CDC, FICD
Senior Medical Director
Steven Canfield graduated from Creighton University School of Dentistry in 1987. He completed a general practice residency at the University of Utah Medical Center in 1988 and started his solo practice shortly thereafter, now in its 33rd year. In 1992 Dr. Canfield began to consult for insurance companies by reviewing dental claims and became a clinical instructor at the University of Utah School of Dentistry in 1994 where he still teaches. Dr. Canfield has been the medical director for Cotiviti’s Dental Claim Accuracy solution since 2012. In this capacity he reviews claims, provides peer-to-peer reviews, and manages a team of consultants that provide claims review and appeals support. He also contributes to the education of analysts and consultants and participates in product development and maintenance.
Cindy Egan, CDC
Cindy Egan-Pugmire has been working in the dental field for over 30 years in various capacities. During that time, she worked in dental offices assisting with many different clinical procedures and became certified as an Expanded Duties Dental Assistant. Cindy has held many positions with Cotiviti including department manager, client account manager, and now works as a dental claims accuracy coding consultant. Her responsibilities include supporting Cotiviti clients’ needs, maintaining the internal edit system, and managing state licensure updates for Utilization Review Agents. Cindy is also a Certified Coding Consultant with the American Dental Coders Association.
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