The NovoHealth Dental platform uses NovoDynamics AI to automatically analyze dental insurance claims in real time at enterprise scale. NovoHealth Dental rapidly evaluates claim quality; accurately supports clinical reviews; and reliably detects fraud, waste, and abuse.

The NovoHealth Dental Platform

Exceeding Expectations

  • Industry-Leading Speed at Enterprise Scale: NovoHealth Dental analyzes claims within seconds, whether the payer chooses real-time streaming or batch uploads. With the default configuration handling more than a hundred million claims per year, NovoHealth Dental's distributed computing model easily scales up as needed.
  • Review Made Easy: NovoHealth Dental brings together all the necessary claim information and documentation in a convenient and intuitive user interface, enabling reviewers to quickly move through automatically prioritized worklists, evaluate findings flagged by our dental AI, add comments, log decisions.
  • Comprehensive Analytics and Configurable Reporting: Use NovoHealth Dental to gain actionable insights that can make your business more successful.
  • Highest Industry Privacy and Security Compliance: HITRUST Certification puts NovoHealth Dental at the forefront of healthcare industry best practices.
  • Flexible Implementation Options: NovoHealth Dental runs in secure, HIPAA-compliant cloud environments (AWS and Microsoft Azure) or can be installed on-premise.
  • Expert Integration Support: NovoDynamics has decades of experience executing enterprise-class integrations. NovoHealth Dental is ready to integrate using our robust APIs.

Pre-Emptive Claim Quality Assessment

NovoHealth Dental immediately analyzes each and every incoming claim in real time before it is routed through the payer’s system. It automatically:

  • Identifies Attachments including various types of radiographs, photographs, charts, correspondence, and notes.
  • Checks Procedure Codes and ascertains whether appropriate evidence has been provided, including radiographs showing the relevant anatomical structures.
  • Triggers Alerts that can be used to instantaneously inform dental offices if any additional information or documentation is required prior to claim processing.
  • Fosters Goodwill by reducing friction between payers and providers.

NovoHealth Dental found more than 76% of claims submitted to a major U.S. dental payer had insufficient documentation.  

Contact us to learn how much time, effort, and frustration NovoHealth Dental could save your team.

Real-Time Clinical Analyses

NovoHealth Dental performs clinical analyses on images and claim data with market-leading speed. It immediately routes clean, compliant claims to the payer’s system for approval and reimbursement. It routes only claims with likely denial issues to professional resources for clinical review.  

  • Pre-Processes Attachments, automatically identifying radiographs, photographs, charts, and documents. NovoHealth Dental classifies radiograph types, segments and identifies teeth, pinpoints anatomical structures, and verifies that the relevant anatomy is included.
  • Uses Even Low-Quality Radiograph Images from screenshots and other non-diagnostic quality files (does not require DICOM files).
  • Performs Accurate Disease Analyses evaluating whether submitted procedures and treatments meet specific insurance plan guidelines.
  • Highlights and Annotates Radiographs to facilitate rapid review.
  • Supports Clinical Decisions with the consistent, objective statistical analyses of our dental AI, which is trained by teams of licensed dentists, including board-certified specialists.

NovoHealth Dental uncovered tens of millions of dollars in potential savings for a major U.S. payer — more than 25X the savings human reviewers had found in the set of claims. 

Contact us to learn how much money NovoHealth Dental could save your organization.

Reducing F/W/A Costs

Image Similarity Detection

NovoHealth Dental compares each incoming radiograph to all available images to ascertain whether it may have been previously submitted. NovoHealth Dental:

  • Recognizes All Similar Images whether they’re identical or may have been manipulated (e.g., cropped, rotated, flipped, skewed, or with adjustments to contrast, color, blurring, etc.)
  • Can Perform Cross-Payer Analyses to uncover radiograph re-use among submissions to multiple insurance plans.
  • Minimizes False Positives by considering all available evidence including metadata, claim data, and information from additional sources to help distinguish likely fraud from legitimate re-use or clerical errors.

Outlier Identification

NovoHealth Dental can help improve focused review processes for payers, as well as reduce risk for DSOs and group practices, by detecting if a provider’s behavior significantly deviates from their peer group or if a provider’s procedure patterns appear suspicious. NovoHealth Dental automatically:

  • Creates More Relevant Provider Peer Groups than traditional systems by integrating external data with a variety of practice and specialty features including more geographic, economic, and population metrics.
  • Performs Hundreds of Tests on each claim to determine if any procedures are anomalous. If one of the tests fails, the claim is flagged for review.

NovoHealth Dental Image Similarity Detection tracked the same radiograph submitted to the same payer by 11 different providers in 6 different states for 10 different patients in 14 different claims over 4 years. Read the full story …

Contact us to learn how NovoHealth Dental could improve your outlier detection and focused review process.

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