AI Use in Claims Processing and Utilization Review

Authors

Robert Rosenthal DDS, Private practice Kernersville, NCFollow

Abstract

This paper investigates the use of artificial intelligence (AI) in claims processing and utilization review in the dental industry. This article aims to explore the potential benefits of AI in this area, such as increased efficiency, accuracy, and fraud detection. The paper begins by providing an overview of the current state of claims processing and utilization review in the dental industry. It then discusses the potential applications of AI in this area, such as automated claims adjudication, predictive analytics, and image recognition. The paper then presents a case study of P&R Dental Strategies, LLC, a leading business intelligence solutions provider to dental payers. P&R has partnered with Denti.AI, a leader in the emerging field of dental image AI, to develop advanced AI-assisted utilization review tools. The paper concludes by discussing the challenges and opportunities associated with AI in claims processing and utilization review in the dental industry. It argues that AI has the potential to revolutionize this area but that further research is needed to understand its benefits and limitations fully.

Recommended Citation

Rosenthal, Robert DDS (2021) "AI Use in Claims Processing and Utilization Review," The Journal of the Michigan Dental Association: Vol. 103: No. 4, Article 3.
Available at: https://commons.ada.org/journalmichigandentalassociation/vol103/iss4/3