Controlling costs while improving outcomes
Controlling costs is critical to a successful and sustainable program. We focus our efforts on managing claims costs because they account for 95% of total program costs. DentaQuest’s unique dental management approach utilizes sophisticated data mining and modeling, statistical analysis tools, and clinical expertise to analyze claims data to ensure each claim expense is appropriate and quality care is delivered.
We have more dentists on staff than any other dental program administrator because this expertise and knowledge is essential to delivering the best possible dental program--one that ensures that patients are receiving the right care, at the right time, by the right provider, and combines extensive clinical know-how with the largest repository of government-sponsored program claims data available anywhere. Our in-depth study of practice patterns of dentists participating in our programs is combined with outstanding clinical knowledge, and enables us to administer high-quality dental programs that are effective, cost-efficient, and truly sustainable.
Utilization management, pre-authorizations, and claim reviews are key methods of minimizing or eliminating potential fraud, waste, and abuse--while maximizing reach and effectiveness of care.
When overutilization is Identified, a variety of highly effective and customizable control measures are used to address the problem. This includes benefit and program design, strong system edit capability, oversight of network composition, and changes in reimbursement. Evidence of fraud, waste, or abuse is reported.
When underutilization is Identified, innovative programs are put into action to promote the use of effective services so patients stay healthy. Emphasizing prevention, our proven programs ensure that higher-risk patients receive the necessary preventive care early—thereby reducing or eliminating costly restorative services in the future.