Dental Plan Cognitive Review: Wins Across Efficiencies, Accuracy, and Time

A leading payer in the dental sector sought Sagility’s expertise to address issues arising from manual handling of dental claims and appeals, resulting in errors and inefficiencies. Sagility employed a comprehensive strategy involving automation, AI, and human review, significantly enhancing accuracy, efficiency, and overall operations.

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About the Client

A recent top-five payer in the dental industry faced just these issues. Not knowing how to solve the issue, they turned to Sagility for assistance. Their goal was to shore up manual reading of unstructured information on dental records and appeals. This was an area where the payer was severely lacking in the dental claims resolution process. 


Storage and Review of Insurance Claims

The storage, reading, and reviewing of insurance claims is a huge and important task in the dental industry. Mislabeled insurance claims can lead to undercharging clients or overcharging them and facing a lawsuit. Additionally, when you read and file claims manually, it eats up valuable time and presents the possibility of human error. 


Initial Review

First, Sagility performed an in-depth review of the client’s dental claims and appeals process. The findings were that misinterpreting information, or missing it altogether, was leading to a large number of incorrect dental records and appeals. Many of these issues were because of human error while manually inputting the information. 


ICP Solution

To ensure the soundness and quality of the review, it was performed in two phases. Phase 1 involved implementing Sagility’s ICP Solution. The ICP Solution was able to use technology to read the chart, narrative, and calculation of the start and stop times on the dental records for the cases and appeals in question. Upon reading everything involved with the cases and appeals, the ICP Solution recommended what course of action to take. 


Upon receiving the ICP Solution recommendation, a review team performed a manual audit on each of the cases and appeals in question. When the client was satisfied with the resolved the issue, the case was closed.


Implementing Automation and AI

Sagility introduced automation and AI in place of manual labor to ensure that all patients were billed at the right cost and received the right care in the correct setting. As a result, there was less administrative burden on the client, which led to fewer costs and payments for the payer. 


Thanks to Sagility’s intelligent machine-learning solution, the client’s review process was faster, more efficient, more thorough, and more accurate. This same solution was then applied to appeals and claims, which resulted in a streamlined appeals process. 


Finally, using a cognitive content processing solution, Sagility was able to address and optimize the overall workflow of the client’s operations. We did this using an image analytics engine capable of processing the source information. Thanks to its built-in natural language processing engine, this cognitive content solution can analyze keywords and context within dental records, resulting in fewer misreads and mislabeled dental records and appeals.  


Thanks to Sagility, the client saw remarkable improvements in speed, accuracy, efficiency, and precision.



In Dental Records and Appeals Review Time



When Processing Records, Claims, and Appeals



In Overall Operations Efficiency

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