Reduce employee costs SAVE MONEY on dental costs! Containing dental costs Dental PPO networks Utilization review bonuses Why self-fund vision?

Brokers PESC Administrators services TPA rate sheet Broker commission schedule Dental plans Vision plans Dental quote Vision quote

Employers Master group application Sample standard plan document Sample network access agreement Sample HIPAA notices Inquiries about claims or benefits

Enrollees PPO provider directories Search for a dentist Search for an optometrist Student status verification form Inquiries about claims or benefits Peer review form

Providers PPO provider agreements PPO provider directories Dental provider search Optometric provider search

About us Company profile Contact us Privacy policy

home

Dental Utilization Review = Maximum Cost Containment !

---

• PESC Administrators = very effective utilization review (UR)
  • Upon receipt, dental claims are carefully screened; those that pass the screening criteria are processed and paid; those that do not are routed for review by practicing PPO dentists who serve as dental directors for PESC Administrators
  • Dental directors may request Xrays, perio charts, or other information to determine if treatment was appropriate and covered as a benefit of the plan; often, they call their colleagues to discuss the claims being reviewed
  • Dental directors decide if alternate benefits should apply, billing adjustments are warranted, or claims should be denied; their decisions are reported on the Explanations of Benefits to patients and dentists
  • Denials can be appealed by dentists or patients by resubmitting claims with additional supporting documentation
  • UR is performed on a weekly basis to avoid delays in claims processing and payments to dentists
  • Dentists know that PESC Administrators operates an aggressive UR program so they are less likely to submit questionable claims
• Utilization review saves employers and patients money by:
  • Eliminating unbundling of services (dentists bill plans for one two-film bitewing and ten intraoral periapical films for a total cost of $180; these services constitute one full-mouth Xray series which are paid at $86 saving the employer $94)
  • Insuring appropriate treatment (dentists submit for crowns on teeth where Xrays show that two-surface fillings are all that patients need; crowns cost $600 or more while two-surface fillings cost $74; employers save $526 on these claims and patients' copayments are reduced from $300 to $14.80)
  • Pro rating payments for treatment (dentists bill for a full quadrant of scaling and root planning at a cost $130 but only treat 3 of the 7 teeth in the quadrant; payment is pro rated to 50% saving the employer $65)
  • Enforcing plan exclusions (dentists bill $95 or more for electric toothbrushes which are not covered benefits)
• PPO dentists who are committed to providing patients with appropriate care and maximum value for their dental dollars developed and now administer PESC Administrators' UR program

 

 

555 W. Shaw Ave., Suite C-1 Fresno, CA 93704

(866) 777-1320 (559) 256-1320 559.256.1321 fax