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

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Recorded On: 10/06/2021

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.

Linda Vidone, DMD

Chief Clinical Officer/V.P. Clinical Management

Delta Dental of Massachusetts

Dr. Linda Vidone is the chief clinical office and vice president of Clinical Management at Delta Dental of Massachusetts. She has 20 years of dental experience in clinical private practice, as dental school faculty, and in the dental benefits industry. Dr. Vidone, a board-certified dental consultant, is a hands-on leader in the dental insurance industry, setting clinical policies and performing routine claim review while staying abreast of innovations in oral health care. She shares her unique knowledge of being on both sides of the claim form while lecturing nationwide on all aspects of dental benefits, dental coding, claim accuracy, utilization management and utilization review. A graduate of Boston University School of Dental Medicine, Dr. Vidone holds a D.M.D. and C.A.G.S. in General Dentistry and Periodontology. She is currently a member of the Delta Dental Plan Association Policy Committee. She is immediate past president of the American Association of Dental Consultants and also serves as chair of the Certification Committee. She is on National Association of Dental Plans Code workgroup and is a voting member of the American Dental Association’s Code Maintenance Committee, where she represents American Health Insurance Plans. She also maintains a private practice in periodontology in Brookline, Massachusetts.


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