Fluent™ Unveils SmartClaimFocus™: A Revolution in Claims Management
An AI-Powered Platform to Optimize the Utilization Management Process
Fluent™, a leader in AI-driven oral health analytics, proudly introduces SmartClaimFocus™, a cutting-edge platform crafted to assist payers in identifying opportunities related to Fraud, Waste, & Abuse (FWA). This innovative solution aims to bolster adjudication strategies and enhance efficiency in utilization management, ensuring that organizations can operate at their highest capability.
The SmartClaimFocus™ platform harnesses the vast dental claims data housed within DentaBase®, recognized as the largest multi-payer dental claims database. Coupling this with Fluent's sophisticated, AI-powered rules engine, the platform minimizes unnecessary noise in data processing and sharpens decision-making for users.
By continuously assessing each client's paid claims history against established practice pattern benchmarks, SmartClaimFocus™ effectively uncovers statistically significant outliers. It emphasizes procedural areas where reviews can yield the greatest impact, enabling payers to allocate resources efficiently for substantial returns. Ultimately, this leads to reduced unnecessary costs and enhanced data-driven decision-making.
Key Features of SmartClaimFocus™
The innovative SmartClaimFocus™ platform offers a range of features designed to streamline claims management:
Provider-Level Breakdown
Users can delve deeply into each procedure rule to pinpoint which providers frequently exhibit risky or outlier behavior. This targeted approach enables focused reviews of those specific providers.
Rule Prioritization
Rules are intelligently ranked based on their potential impact on FWA. This prioritization empowers users to concentrate on the most significant opportunities for mitigation first.
Focused Review Options
Following the identification of high-impact risk areas, users can select distinct providers and CDT codes for targeted investigations. Additionally, they can monitor review volumes and savings achieved directly within the platform.
Processor View
This view showcases the areas where adjudication processes intersect with standard FWA processing rules, along with detailed insights into the financial implications of those rules.
Data Export Capability
All views within the platform support easy data export, facilitating information sharing and coordinated follow-up actions among teams.
Estimating FWA Impact
Users can assess the potential impact associated with inactive rules, identifying vital opportunities for increased efficiency and cost savings.
"Payers require tools that simplify the complexities of claims data, and that's precisely what SmartClaimFocus™ offers," expressed Paul Sheils, CEO of Fluent. "It provides clear visibility into where savings can be achieved, where opportunities are being overlooked, and how to effectively align resources for maximum impact. Our aim is to make claim review more strategic rather than complicated."
With its ability to identify inappropriate behaviors and highlight hidden risks, SmartClaimFocus™ provides payers with a singular platform to detect, prioritize, and act on the most pressing issues. This launch represents a significant advancement in Fluent's commitment to innovation, with additional products in development to further position Fluent as a primary resource for payer clients.
About Fluent™
Fluent is recognized as the trusted oral health analytics platform that marries profound data insights, intelligent AI, and expert services to promote more competent care and operational efficiencies. It boasts a database built on over 6.6 billion dental claims, growing at an annual rate exceeding 10%. Supported by more than 70 national and regional payers, Fluent serves over 225,000 dentists, 189,000 locations, and 110 million commercial patients. The solutions we provide encompass utilization management, provider lifecycle management, and advanced analytics, equipping stakeholders within the dental ecosystem to make informed decisions that lead to improved patient outcomes.
Frequently Asked Questions
What is SmartClaimFocus™?
SmartClaimFocus™ is an AI-powered platform developed by Fluent™ to enhance utilization management and assist payers in identifying Fraud, Waste, & Abuse opportunities.
How does SmartClaimFocus™ improve claims management?
It integrates dental claims data with an AI-driven rules engine to provide insightful analytics that improves decision-making and reduces unnecessary costs.
Who can benefit from using SmartClaimFocus™?
Payers, providers, and stakeholders in the dental ecosystem can leverage the platform to optimize management processes and enhance operational efficiency.
What data does SmartClaimFocus™ utilize?
The platform utilizes data from DentaBase®, the largest multi-payer dental claims database, to provide comprehensive analytics.
What are Fluent's plans for future products?
Fluent™ is actively developing more innovative products designed to further enhance their offerings within the healthcare analytics sector.
