The Promise of Real-Time Adjudication: Can AI deliver?

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Recorded On: 10/06/2021

Overview
Speaker(s)

As Artificial Intelligence (AI) systems, capable of accurate radiographic diagnosis, begin to penetrate the dental industry, carriers have emerged among the earliest adopters of the technology. The benefits of computer vision-powered utilization management and review – efficiency, automation, comprehensive claim examination, fraud detection and, of course, real-time adjudication – have been extolled by every dental AI startup bringing utilization management/utilization review (UM/UR) solutions. Though real-world application of the technology too limited and nascent to have produced clear evidence of those benefits, most insurers – even those who have yet to see the technology in action – seem willing to grant that, at least in principle, AI holds considerable promise for the future of claim adjudication. The question is: Could that promising future actually include real-time claims adjudication? The Dental AI Council (DAIC) would like to try to answer that question with the help of members of the DAIC leadership committee, who will bring their dental care, insurance carrier, and AI experience to bear. They will address:

Benefits of real-time adjudication for providers, patients and carriers
Why AI holds promise for real-time adjudication
Logistical impediments to real-time adjudication
Regulatory impediments to real-time adjudication
How to overcome impediments
Steps that can be taken to facilitate a real-time reality

Dr. Kyle Stanley

CCO

Pearl

Dr. Kyle Stanely, DDS, is an award-winning dentist and the chiefclinical officer at Pearl, an AI company specializing in diagnostic andbusiness analytics solutions for the dental industry. A graduate and formerfaculty member of USC’s Herman Ostrow School of Dentistry, Dr. Stanley’sesthetics, dental implant, and smile design research has been published in thetop international dental journals. He has been honored with the AAED’s CharlesL. Pincus Award for outstanding achievement in esthetic dentistry and named tothe AACD’s "The Next Generation of Cosmetic Dentistry" and SeattleStudy Club’s "Top 10 Young Educators in Dentistry" lists. As a keyopinion leader and public speaker, Dr. Stanley has become the dental industry’sleading advocate for mental health awareness. His private practice is locatedin Beverly Hills, CA.

Dr. Linda Vidone

Chief Clinical Officer & Vice President of Clinical Management

Delta Dental of Massachusetts

Linda Vidone, DMD, is Delta Dental of Massachusetts's (DDMA) chief clinical officer and vice president of clinical management. She has 20 years of dental experience in clinical private practice, dental school faculty, and the dental benefits industry. She is responsible for all clinical programs at DDMA, which include dental/medical integration, utilization review, and management, oral health analytics, benefit criteria, clinical and contractual appeal review, and sets standards for quality care, confirming that DDMA maintains a quality network of providers. She continuously stays abreast of innovations in oral health, ensuring that DDMA continues to enhance and provide the best dental benefits to its customers. Dr. Vidone is a liaison to the National Scientific Committee and Policy Committee for Delta Dental Plans Association.

Dr. Vidone is a hands-on leader in the dental insurance industry. Beyond her work with DDMA, she is the immediate past president and chair of the American Association of Dental Consultants Certification and Program Committees. She is the chairperson of the National Association of Dental Terminology workgroup, a voting member of the American Dental Association’s Code Maintenance Committee, representing American Health Insurance, and a voting member of the Dental Quality Alliance and serving on their educational committee. She holds membership with the American Dental Association and American Academy of Periodontology, National Healthcare Fraud Association, and New England Dental Society. She lectures nationally on Dental insurance, Claim coding, Opioid Epidemic in Dentistry, and Quality in Oral Health.

She received her DMD and advanced certificates in Prosthetics and Periodontology at Boston University and a bachelor’s degree in biology from Providence College. She maintains a private practice in Periodontology in Brookline, Massachusetts.