Artificial Intelligence and Dental Claims Review: A More Predictable Consumer Experience

The era of data-driven health care is almost here. The future of dental benefits and claims adjudication will soon be powered by artificial Intelligence that uses smart technology to identify and predict treatment outcomes.

AI is objective, based in science and driven by data. It has many benefits for consumers, dentists and insurers.

Benefits for the consumer

AI levels the playing field for consumers, looping them into the decision-making process when it comes to possible treatments and — in almost real time — letting them know how much insurance will pay and what will be required out-of-pocket. It can empower consumers by delivering a more predictable experience. Their individualized treatment protocols are based on both their dentist’s recommendation and data-driven best practices as collected and provided by AI.

Benefits for dentists

Dentists will find that AI can help them provide clearer guidance on treatment and procedure options for their patients. AI will help facilitate their interactions with the consumer and insurance company. When a second opinion is sought, dentists can use AI to provide real-time counsel that is based on objective data that comes from reviewing the results of patients with similar conditions. When it comes time to submitting a claim, AI can remove subjectivity, making for a more equitable process.

Quinn Dufurrena, D.D.S., J.D.

Benefits for insurers

On the insurance side, AI increases both speed and efficiency in determining claims. Settling multiple claims in a reduced amount of time can help streamline the process and assist in preventing human error, such as claims with missing information that often cause delays in decisions. AI also facilitates understanding of the need for treatments, as recommended by the dentist, helping insurers and dentists more closely align regarding the care provided.

We’ve entered an exciting new chapter in the world of dental solutions and benefits. In other disciplines, we have computers measuring vision problems, bone loss and other routine medical problems. Now, the same accurate technology — AI — can be applied to dentistry, helping align all involved parties on the appropriateness of care.

Rooted in science and unbiased in nature, AI promotes and facilities a shared understanding of care and claims between consumers, dentists and insurers.

Quinn Dufurrena, D.D.S., J.D., is chief dental officer for United Concordia Dental, a national dental insurer headquartered in Camp Hill, Pennsylvania.