Insuranceciooutlook

How AI-Backed Claims Approval Solutions Minimize Dental Insurance Fraud

By Insurance CIO Outlook | Wednesday, February 19, 2020

Artificial intelligence-powered visual analytics tools are revolutionizing claims processing and approval for dental insurance providers.

FREMONT, CA: Pearl has released two new AI software solutions to facilitate claims processing for dental insurance companies- Pearl Claims Approval and Pearl Protect. The breakthrough set of solutions will allow dental insurance companies to improve automated claims approval processes by lending it an excellent amount of intelligence, which will subsequently narrow down the chances of fraud. For companies proving dental insurance products, these solutions from Pearl are expected to be valuable in more ways than one.

The challenge of fraud in dental insurance has been a persistent one, and insurers have incurred significant losses. These frauds happen because insurers lack the means of detecting claims where the same images and x-rays are used multiple times. With Pearl's AI-backed solutions, detailed scrutiny of images is possible, enabling insurance companies to overcome vulnerabilities. Pearl Protect can detect and flag any 2D image that is a duplicate of another image that has already been used for claims. The software is equipped with the intelligence to automatically analyze images and cross-check to ensure every image in every claim is unique.

The second software, Pearl Claims Approval, is devised to segment claims after conducting visual analysis of the accompanying images and scans. The segmentation classifies claims as strong, moderate, or weak. This classification enables insurers to automate approvals further and eliminate the requirement of multiple claim submissions. Thus, insurers can generate more efficiency when it comes to processing a high volume of claims, while simultaneously making the process faster. The artificial intelligence engine behind Pearl Claims Approval is empowered to compare claims images against valid claims criteria.

Pearl has been working towards building AI applications for the dental industry. The company was founded with the belief that AI when applied to dental care, can make a big difference for service providers, as well as patients and customers. The suite of AI solutions that Pearl has developed is backed by proprietary technologies which can help identify issues faster and better.

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