P&R employs dental benefit industry experts to address your specific business needs. Based on expert clinical and business insights gained through years of experience, P&R provides consultative support in the following areas:

Utilization Review

Determine the most common items that require additional clinical review. Design and implement a utilization review program. Assess quality and help select the appropriate reviewers. Develop and implement a program for state compliance.

Utilization Management

Establish a quality assurance program that doesn't sacrifice member quality. Assess and rank order providers in a network. Determine appropriate metrics to measure quality of care with providers.

Dental Provider Profiling

Implement effective provider education programs. Perform statistical analysis for profiling a network of dentists. Provide insights into practice patterns. Assess appropriate metrics with which to assess dentists.

Dental Fraud and Abuse

Target providers whose practices appear to be submitting fraudulent or abusive claims. Leverage the largest cross-payer dental claims database to detect additional fraudulent behavior. Develop methods by which to determine fraudulent and abusive practices. Provide expert testimony in cases of fraud and abuse.

Dental Network Development

Assess the criteria that should be used to determine which providers should and should not be in your network. Determine appropriate targets for inclusion in the network. Assess a network's strengths and weaknesses, and where improvements are indicated.

Dental Benefit Design

Design a benefit plan that offers employers the most benefits for their premium dollar and provides them a competitive advantage.

Dental Edit System Development

Institute an edit system that honors contractual guidelines, is designed for additional cost containment and includes appropriate dental logic. Develop an edit system that reduces the requirement for additional clinical oversight.