Payers can lead the way in modernizing commercial dental benefit administration

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Payers can lead the way in modernizing commercial dental benefit administration


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By automating commercial dental benefit administration, payers can lower costs and improve profitability while enabling better service to providers and members. However, simply acquiring and implementing the hardware and software will not alone move the dental industry forward. Leveraging technology to create a system that drives efficiency, offers adaptability and engages providers and members must all be part of the equation.

Dental payers can no longer rely on the processes, methodologies and technologies of the past. They must adopt new technologies that deliver the level of performance required to compete in today’s digital world. That means commercial dental payers must be able to respond quickly to evolving market factors, such as the consumerization of healthcare and the need to manage risk more effectively. They must also be able to rapidly scale up their operations when the addition of new offerings or new markets results in a sudden intake of thousands of new members.

Failure to manage these factors effectively can result in lost market opportunities, out-of-control costs that negate any top line revenue gains, poor provider and member service, compliance issues, and ultimately a negative reputation that can be difficult to overcome. This is especially true today, when social media and user reviews have so much impact on purchasing decisions.

End-to-end automation

Replacing manual processes and outdated systems with automated technologies solves these issues. Automated technologies can perform thousands of repetitive operations, such as the intake and adjudication of clean claims, in seconds, improving responsiveness and scalability by greatly increasing both throughput and accuracy. This type of end-to-end automation lays the groundwork for same-day payment of claims to providers, as well as the faster generation of an explanation of benefits to speed the reimbursement process from members.

Automation also increases efficiency by replacing manual paperwork with electronic options. Just 48% of dental transactions are being done electronically, according to 2021 data. Encouraging providers to submit claims electronically and accept payments by electronic funds transfer helps speed the processing of claims while reducing costs for both payers and providers. It’s estimated that dental health plans and providers could save $1.9 billion a year by fully adopting electronic transactions.

By automating processes wherever possible, payers gain the ability to take advantage of rapidly developing market opportunities while reducing benefit costs and improving provider satisfaction. Replacing manual credentialing applications with automated “one-and-done” options helps payers build high-quality provider networks faster and with less cost while improving dental provider satisfaction.

An automated system eliminates the possibility of human error, and compliance requirements for commercial dental applications can be built into the system to ensure the payer is meeting all applicable federal and state regulations.

Eliminating fraud, waste and abuse

The success of any dental network ultimately depends on the quality of the providers within it. Members interact with their dentists far more than their dental payer, and tend to judge the entire program on the basis of their ability to easily access quality care.

Building a high-quality network is also key to the goal of eliminating fraud, waste and abuse, both to reduce costs and protect patients from the risk of receiving unnecessary (and often painful) treatment. These factors make it imperative to not only find high-quality dentists for the dental network but also to offer them benefits beyond standard reimbursement so they remain engaged with the payer.

Automated technologies help fulfill this goal by making it possible to establish a fully electronic relationship, from contracting and credentialing to submitting claims to receiving reimbursement. The more time dentists can save on administrative tasks, the more time they have to do what they went to dental school for, delivering patient care. And the more they’re focused on care, the more likely they are to deliver the level of quality their patients deserve.

Technologies such as on-demand online access for providers further improve the relationship by enabling dentists to obtain answers to questions about pending authorizations, claim payment status and more. Online access to information can dramatically reduce call volumes, which in turn saves payers money, makes dental offices more efficient and improves satisfaction.

Using data to control costs

The cost of delivering dental benefits continues to rise. Not just the administrative costs, which account for 2% to 4% of the total, but also the cost of the benefits themselves. Left unchecked, these benefit costs can grow to the point where an apparently successful program could jeopardize the payer’s bottom line. Payers must ensure they manage benefit costs as they grow in order to remain competitive.

Dental payers have accumulated stores of data regarding every aspect of their businesses. By using big data analytics and leveraging expertise to interpret the results accurately and make prescriptive recommendations, payers can manage benefit administration programs in a way that increases access to quality care while driving down costs.

With the right analytics tools and the expertise to support them, payers can elevate program performance to the highest levels, making their programs more competitive, improving provider satisfaction and increasing profitability.

A 2021 Dreamit Ventures survey of healthcare CIOs underscores the importance of working with a well-established digital partner to address urgent problems, deliver provable ROI and improve provider workflows, and dental payers should take note.

By working with a trusted partner to scale to the business needs, encourage providers to establish fully electronic relationships, and use big data analytics to measure and improve program performance, dental payers can lead the transformation of the industry to the benefit of all stakeholders, from payers to providers to members.

Photo: Nastasic, Getty Images



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