In addition to providing dental claim editing, Verscend employs dental coders and specialists to perform clinical review and return payment recommendations to the client within hours of receipt and processing into Verscend’s systems. Verscend’s licensed dentists also perform dental consultant review when claims require additional clinical analysis or medical necessity review.
Dental fraud profiling takes place in parallel with claim editing and review, consisting of analysis and scoring of provider billing behavior to identify potentially fraudulent billing patterns and adjust edit scrutiny accordingly.
Verscend's automated editing logic and clinical review payment recommendations are sourced from nationally recognized coding standards to ensure that denials and reductions are defensible. In cases where providers appeal these decisions, Verscend’s clinical experts process appeals on behalf of clients, providing additional explanations to support our coding and payment recommendations.
Results? Verscend saved one client $417,000 on analyzed paid claims of $22 million (1.7 percent) in 2015 from Dental Accuracy’s claim editing and clinical review capabilities alone*.
* Based on specific client savings reports. Individual results will vary.