FINEOS Claims for Dental

Now is the time for innovative dental benefits providers to turn claims management into a competitive advantage

The dental benefits industry is facing an exciting — and challenging — time.  Flexibility is key, as the market becomes increasingly customer-driven.  Employer groups, benefits administrators and individuals are demanding the ability to select products and services to meet their own needs. At the same time, claims payors must find ways to cut their loss ratios by reducing claims leakage and increasing auto-adjudication. Innovative institutions will be those who can address both challenges.

With FINEOS Claims for Dental, dental claims payors can streamline the claim process and offer innovative products and plan designs. 

Engineered for Flexibility

FINEOS Claims for Dental is unlike traditional claims systems, which are restrictive in their expectation of dental product structure.  The solution provides maximum configurability to change the way plans are defined, allowing for cafeteria-style selection and maintenance. And because it's rules-based, FINEOS Claims for Dental allows changes to plans and products to be made quickly and easily at the business level.

Designed for Operational Efficiency

FINEOS Claims for Dental helps streamline the claims management operation by increasing auto-adjudication rates and delivering higher throughput rates. The solution provides straight-through processing of common claim types, so high volumes of claims can be processed efficiently, with minimal manual effort.  Configurable business rules determine whether claims are paid, pended, or denied.

In cases where claims must be processed manually, FINEOS Claims for Dental provides detailed decision-support and enforces best practices.  Claims are routed appropriately according to skill and authority level and are automatically checked against benefit accumulators and policy provisions.

Developed for Optimal Provider Management

FINEOS Claims for Dental allows dental benefits providers to maintain and manage complex vendor networks, whether they are proprietary or third-party. The solution manages providers and facilities requiring multiple fee schedules, automatically cross-checking claims against provider contracts.  FINEOS Claims for Dental provides insight into provider utilization, allowing management to report on procedures and claims on a per-provider basis.

FINEOS Claims for Dental goes beyond traditional claims processing to deliver all aspects of a total claims solution:

  • Fully automated claims and case management
  • Integrated customer management
  • Comprehensive financial management
  • Optimal provider management
  • A flexible, modern, rules-driven technology platform