Artificial Intelligence Platform Immediately Reviews Every Claim Submitted
NovoDynamics, Inc., the proven artificial intelligence (AI) and advanced image analysis company, and Delta Dental of Michigan (DDMI) today announced they have added real-time AI analysis to the payer’s claim processing workflow to accelerate adjudication and reduce reimbursement times. The NovoDynamics® NovoHealth® Dental platform immediately reviews the thousands of claims streaming daily into the DDMI system via provider portals, clearinghouses, and mail. NovoHealth Dental analyzes claims for completeness and compliance to specific insurance plan guidelines; checks for potential fraud, waste and abuse; routes suspect claims to reviewers; and provides support for clinicians’ decisions with accurate, data-driven disease assessments — all in real time.
“We’ve been using NovoHealth Dental to batch analyze our claims since 2019, but now the AI reviews each claim as soon as it’s submitted. Our system can now immediately alert providers when claims are incomplete or incorrect and automatically ensure that claims meet our standards and guidelines. When claims require human review, NovoHealth Dental annotates the associated radiograph (x-ray) images and automatically routes them to our analysts,” said Delta Dental of Michigan Senior Vice President and Chief Science Officer Dr. Jeffery Johnston. “The new real-time workflow ensures every claim is thoroughly reviewed before being paid, which will help save everyone time, effort, and money.”
“NovoHealth Dental also gives dental practices the benefits of AI-assisted claim review without having to change the way they submit their claims to payers or install any new software,” added NovoDynamics CEO David Rock. ”Because it optimizes radiographs for AI analysis with the advanced image processing techniques NovoDynamics initially developed for the U.S. Intelligence Community, NovoHealth Dental can deliver even high-quality clinical analysis using the low-quality, non-diagnostic images payers typically receive.”
NovoHealth Dental’s claim quality assurance and clinical analysis modules automatically check to be sure all required attachments are submitted, that correct procedure codes are applied, and whether the patient’s specific insurance plan guidelines are met. If duplicate radiographs appear in multiple claims, NovoHealth Dental’s F/W/A detection module reliably differentiates fraud from legitimate re-use or likely clerical errors. NovoHealth Dental integrates historical and external data to enhance analyses, and employs machine learning to continually improve its AI’s performance. The NovoDynamics NovoHealth Dental platform’s enterprise-class default configuration can process over 373 million claims per year (more than a million claims per day) and can easily be scaled to handle even higher volumes.
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