NovoDynamics, Inc., the leading provider of automated, AI-driven dental insurance claim review technology, today announced that clinicians examining claims for Delta Dental of Michigan, one of the nation’s largest dental insurers, consistently concurred with the selection of claim line items that NovoDynamics NovoHealth Dental flagged to be reviewed for potential denial. The rate at which human healthcare experts agree with machine-based findings is regularly used to determine the accuracy of AI in assessing medical conditions. During a 10-month pilot program, NovoHealth Dental automatically screened more than 120,000 claim line items submitted for certain types of periodontal procedures.
The system flagged those it recognized as not providing sufficient clinical evidence for approval and routed them for further review by Delta Dental of Michigan clinicians, who agreed with the NovoHealth Dental denial recommendations more than 86% of the time. A separate dental industry baseline study showed that after a secondary review, dental clinicians agreed with their own prior diagnosis only 84% of the time.
NovoHealth Dental accuracy addresses the burden of unnecessary claim reimbursements generating avoidable costs for the dental industry
Dental insurance companies are required to have a credentialed clinician review a claim before it can be denied for not meeting their clinical guidelines. But because payer claim volume often far exceeds the capacity of review staff, insurers do not have the capacity to manually review every claim submitted, so they typically perform spot checks, instead.
This gives rise to two issues: 1) Some claims are approved despite not meeting clinical requirements for reimbursement, and 2) Since it’s challenging for insurers to determine which claims are most likely to fail to meet clinical guidelines, the ratio of time spent by clinicians on deniable versus admissible claims selected for review may be low. Because NovoHealth Dental automatically screens every claim submitted and reliably routes for review those most likely to fail to meet clinical guidelines, insurers can be confident that their clinical reviewers’ time and efforts will be optimized, and their plan payment savings will be maximized. Providers also benefit because their clearly admissible claims aren’t delayed by inconsequential reviews.
Rigorous analysis validates the capabilities of NovoHealth Dental running in real time in a demanding, high-volume, enterprise environment
Deployed in the insurer’s real-time production environment in 2023, NovoHealth Dental has been automatically screening claims containing reimbursement requests for scaling and root planing (SRP) procedures that were submitted to Delta Dental of Michigan and its affiliates in two other states. SRP procedures are used by dental practitioners to treat periodontitis (gum disease). A claim may be denied when the procedure does not appear to meet payer clinical guidelines, such as when insufficient bone loss to warrant an SRP procedure is detected on the radiographic (x-ray) image. Even when radiographs are attached to insurance claims as low-quality screenshots (which is a standard practice for many dental offices), NovoHealth Dental excels at accurately determining whether sufficient bone loss is present.
“The high rate at which NovoHealth Dental accurately predicts which claims would be denied by clinicians makes a very compelling case for its use in helping to select which dental claims to review,” said Delta Dental of Michigan senior vice president and chief science officer, Dr. Jeffery Johnston. “We believe AI technology that screens, flags, and prioritizes the right claims for review as reliably as NovoHealth Dental does can substantively increase the productivity of our staff.”
In addition to assisting insurers with presorting claims for clinician review in real time, NovoHealth Dental pre-emptively identifies claims that are missing required documentation, as well as claims that have been submitted with critical errors, allowing dental offices to immediately make corrections. Finding claim issues as quickly as possible reduces administrative time and costs for the entire dental industry.
“We are excited to be giving payers the real-world data and confidence they need to make informed decisions about integrating our dental AI into their claim review workflows,” said NovoDynamics CEO, David Rock. “The recent Delta Dental of Michigan results provide solid evidence that NovoHealth Dental brings quantifiable benefits to the entire dental ecosystem: It helps payers evaluate claims more quickly and consistently while better controlling costs. It makes it easier for providers to submit compliant claims and obtain faster reimbursement decisions and payments. And consequently, it can offer patients better information when faced with making dental treatment decisions.”
About Delta Dental of Michigan
Delta Dental of Michigan and its affiliates in Arkansas, Indiana, Kentucky, New Mexico, North Carolina, Ohio, and Tennessee make up one of the largest dental plan administrators in the nation. The Delta Dental plans are members of the Delta Dental Plans Association, a nationwide system of independently operated dental health service plans. Together, the plans provide coverage to more than 78 million Americans and operate two of the nation’s largest networks of participating dentists.
About NovoDynamics
NovoDynamics provides artificial intelligence (AI) solutions that address critical healthcare challenges, save payers and providers time and money, and help improve quality of care for patients. The company’s NovoHealth Dental platform analyzes dental insurance claims in real time; delivers accurate clinical assessments; helps deter fraud, waste, and abuse; and supports more consistent plan payments. NovoDynamics, an In-Q-Tel portfolio company, has been applying its proven AI expertise and advanced image processing technology to solve complex problems for governments, commercial enterprises, and academic institutions since 2001.
For more information, follow NovoDynamics on LinkedIn or visit NovoDynamics.com.
Delta Dental is a trademark of the Delta Dental Plans Association.
The Delta Dental Plans Association does not make any representations, warranties or endorsements with respect to NovoDynamics, Inc. or its products.
FEATURED IMAGE CREDIT: Igor Omilaev on Unsplash.
