ANN ARBOR, Mich.–(BUSINESS WIRE)–NovoDynamics, Inc., a leader in automated, AI-driven dental insurance claim review technology, has announced that clinicians at Delta Dental of Michigan have consistently agreed with the claim line items flagged by NovoHealth® Dental for potential denial. Delta Dental is one of the largest dental insurers in the United States.
The accuracy of AI in assessing medical conditions is often measured by the agreement rate between human experts and machine findings.
In a 10-month pilot program, NovoHealth Dental screened over 120,000 claim line items related to specific periodontal procedures. The AI system identified claims lacking sufficient clinical evidence for approval and sent them for further review. Delta Dental clinicians agreed with the AI’s denial recommendations more than 86% of the time. In contrast, a separate industry study found that clinicians only agreed with their own previous diagnoses 84% of the time after a secondary review.
NovoHealth Dental’s accuracy helps reduce unnecessary claim reimbursements, which can lead to avoidable costs in the dental industry. Dental insurance companies must have a credentialed clinician review claims before they can be denied for not meeting clinical guidelines. However, due to the high volume of claims, insurers often cannot review every claim manually and typically conduct spot checks. This can result in two main issues: some claims may be approved without meeting clinical requirements, and clinicians may spend too little time on claims that are likely to be denied.
NovoHealth Dental addresses these challenges by automatically screening all submitted claims and routing those most likely to fail clinical guidelines for review. This ensures that clinical reviewers can focus their time effectively, maximizing savings for the insurance plans. Additionally, providers benefit as their legitimate claims are not delayed by unnecessary reviews.
In 2023, NovoHealth Dental was deployed in Delta Dental’s real-time production environment, screening claims for scaling and root planing (SRP) procedures. These procedures are essential for treating periodontitis (gum disease). Claims can be denied if they do not meet payer clinical guidelines, such as insufficient bone loss detected in radiographic images. Even when low-quality screenshots of radiographs are submitted, NovoHealth Dental accurately assesses whether adequate bone loss is present.
Dr. Jeffery Johnston, Senior Vice President and Chief Science Officer at Delta Dental of Michigan, stated, “The high rate at which NovoHealth Dental accurately predicts which claims would be denied by clinicians makes a compelling case for its use in selecting dental claims for review. We believe that AI technology, which screens, flags, and prioritizes the right claims for review, can significantly enhance our staff’s productivity.”
Beyond assisting insurers in presorting claims, NovoHealth Dental also identifies claims lacking required documentation or containing critical errors, allowing dental offices to make immediate corrections. This rapid identification of claim issues helps reduce administrative time and costs across the dental industry.
David Rock, CEO of NovoDynamics, expressed excitement about providing payers with real-world data to support the integration of dental AI into their claim review processes. He noted that the results from Delta Dental of Michigan demonstrate that NovoHealth Dental offers quantifiable benefits to the dental ecosystem. It helps payers evaluate claims more quickly and consistently, controls costs better, and enables providers to submit compliant claims for faster reimbursement. Ultimately, this can lead to better information for patients when making dental treatment decisions.