By automating commercial dental benefits management, payers can reduce costs and increase profitability while providing better service to providers and members. However, acquiring and implementing hardware and software alone will not move the dental industry forward. Leveraging technology to create a system that increases efficiency, provides adaptability, and engages suppliers and members must all be part of the equation.
Dental payers can no longer rely on the processes, methods and technologies of the past. They must embrace new technologies to deliver the level of performance required to compete in today’s digital world. This means commercial dental payers must be able to respond quickly to changing market factors, such as the consumerization of healthcare and the need to manage risk more effectively. They must also be able to scale their operations quickly when the addition of a new product or new market results in the sudden absorption of thousands of new members.
Failure to manage these factors effectively can lead to lost market opportunities, runaway costs that lose any top-line revenue benefits, poor provider and membership service, compliance issues, and ultimately a negative reputation that is difficult to overcome. This is especially true today, as social media and user reviews have such a large influence on purchasing decisions.
end-to-end automation
Replacing manual processes and outdated systems with automated technology can solve these problems. Automated technology can perform thousands of repetitive operations, such as processing and adjudicating clean claims, in seconds, improving responsiveness and scalability by greatly increasing throughput and accuracy. This type of end-to-end automation lays the foundation for same-day payment of claims to providers and faster generation of benefit explanations to expedite the reimbursement process for members.
Automation also increases efficiency by replacing manual paperwork with electronic options.According to the data, only 48% of dental transactions are done electronically 2021 data. Encouraging providers to submit claims electronically and accept payments via electronic funds transfer can help speed up the processing of claims while reducing costs for payers and providers.Dental health plans and providers are estimated to save $1.9 billion annually by fully adopting electronic technology trade.
By automating processes wherever possible, payers are able to capitalize on rapidly evolving market opportunities while reducing benefit costs and improving supplier satisfaction. Replacing manual certification applications with automated “one-off” options helps payers build a high-quality provider network faster and at a lower cost, while increasing dental provider satisfaction.
Automated systems eliminate the possibility of human error, and compliance requirements for commercial dental applications can be built into the system to ensure payers comply with all applicable federal and state regulations.
Eliminate Fraud, Waste and Abuse
The success of any dental network ultimately depends on the quality of the providers within it. Members interact with dentists far more than their dental payers and tend to judge entire programs on their ability to easily access quality care.
Building a high-quality network is also key to eliminating fraud, waste, and abusive targets, both to reduce costs and to protect patients from the risk of receiving unnecessary (and often painful) treatment. These factors make it imperative not only to find high-quality dentists for the dental network, but also to provide them with benefits beyond standard reimbursement so that they can continue to stay connected to payers.
Automation technology helps achieve this by creating a fully electronic relationship, from signing contracts and certifications to submitting claims to receiving reimbursements. The more time a dentist can save on administrative tasks, the more time they must have to do the same things they go to dental school to provide patient care. The more focused they are on care, the more likely they are to deliver the level of quality patients deserve.
Technologies such as provider on-demand online access allow dentists to get answers to questions about pending authorizations, claims payment status, and more, further improving this relationship. Accessing information online can significantly reduce call volume, saving payers money, increasing dental practice efficiency and increasing satisfaction.
Use data to control costs
The cost of providing dental benefits continues to rise. Not just the administrative cost of 2% to 4% of the total cost, but the cost of the benefits themselves. If 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 to remain competitive.
Dental payers have amassed data on every aspect of their business. By using big data analytics and leveraging expertise to accurately interpret results and make prescriptive recommendations, payers can manage benefit administration programs that increase access to quality care while reducing costs.
With the right analytics tools and the expertise to support them, payers can drive program performance to the highest level, make their programs more competitive, increase provider satisfaction, and increase profitability.
2021 Dreamit Ventures survey of healthcare CIOs highlighted the importance of working with established digital partners to solve pressing problems, deliver demonstrable ROI, and improve provider workflow, something dental payers should take note.
By partnering with trusted partners to meet business needs, encouraging fully electronic supplier relationships, and using big data analytics to measure and improve project performance, dental payers can lead an industry transformation for the benefit of all stakeholders, from Payer to Supplier to Member.
Photo: Nastasic, Getty Images
