NovoHealth Dental is Taking a Big Bite Out of Dental Insurance Fraud
ANN ARBOR, Mich., December 7, 2020 – At the recent National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference, Delta Dental of Michigan Vice President and Chief Science Officer Dr. Jeffery W. Johnston reported that NovoDynamics® NovoHealth™ Dental software, which has been deployed company-wide to fight dental insurance fraud, has already found millions of dollars in potential savings for the insurer.
In his NHCAA presentation, “Delta Dental of Michigan Takes a Bite Out of Fraud with AI Technology,” Dr. Johnston shared one case of a single radiograph appearing in 14 different claim submissions for 10 different patients located in different parts of the country, by 11 different providers, over a period of 4 years.
While duplicate radiograph submissions may sometimes simply be clerical errors, if the intent is fraud, it’s easy, today, to use digital photo editing tools to alter radiographs so it’s difficult to recognize them as duplicates.
“We never would have been able to uncover all these duplicate radiograph submissions without NovoHealth Dental,” said Dr. Johnston. “With months or years elapsing between duplicate submissions, it’s almost impossible for a human reviewer to recall seeing the same image. Moreover, claims containing duplicate images may be routed to different reviewers. The NovoHealth Dental system never forgets a radiograph it’s seen before, and it even recognizes altered images as duplicates.”
Because of the huge volume of dental claims submitted to insurers like Delta Dental of Michigan each year, clinical analysts tasked with validating submissions can review only a small percentage of cases. NovoHealth Dental, powered by NovoDynamics AI (artificial intelligence), quickly and accurately assesses every claim submitted to the insurer’s system. It analyzes all claim-related files, including digital images such as radiographs, photographs, periodontal charts and scanned documents. NovoHealth Dental automatically detects anomalous claims, such as duplicate radiograph submissions, and serves up a prioritized queue for clinician review, ensuring that the insurance company’s valuable human resources are utilized as efficiently and effectively as possible.
“When we added NovoHealth Dental to our claims processing system last year, our savings potential more than doubled. We’ve already identified millions of dollars in potential savings,” said Dr. Johnston. “Before we deployed NovoHealth Dental, our analysts were able to review fewer than 1% of submitted claims. No issues were found in approximately 60% of the claims reviewed, so they were still paid. NovoHealth Dental analyzes 100% of the claims submitted, then sends only those with a high likelihood of fraud to our analysts for review. So, with the same number of analysts, we can find far more claims with actual issues — before they’re paid,” Dr. Johnston explained.
The NovoDynamics NovoHealth Dental platform will do far more for the dental industry than just fight fraud. According to NovoDynamics CEO David Rock, “NovoHealth Dental is designed to streamline and analyze dental insurance claims — from the dentist’s chair to the insurer’s claim processing system. By automating claim submissions, it will not only save time and effort for dental practices and insurers, it will also accelerate reimbursement by ensuring that submissions meet insurer guidelines. While NovoHealth Dental image anomaly detection uncovers fraud, our disease assessment technology provides consistent, statistical support for diagnoses and treatment decisions. NovoHealth Dental adds value for and goodwill between all constituents — insurers, DSOs, practitioners and, ultimately, patients who will benefit from the assurance that they are receiving appropriate care.”
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.
NovoDynamics, Inc., an In-Q-Tel portfolio company incorporated in 2001, leverages its pre-eminent data extraction, data integration, pattern recognition and predictive analytics technologies to develop artificial intelligence software and solutions that address highly complex challenges. The company’s AI expertise and technology have been used to create powerful solutions for major companies and organizations across a variety of different industries, including Health Care. NovoDynamics® products transform large, disparate data sets into actionable information and insights that help organizations make better decisions. NovoDynamics® products are used worldwide by commercial industries, governments and academia. Learn more at NovoHealthDental.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.