Catalyst for Change: SKYGEN Helps Dental Plans Find & Correct Inappropriate Care

Analytics can help identify gaps in dental plan business rules that lead to inappropriate care and high costs. But can analytics increase availability of preventive care resources or providers’ adherence to quality standards? 

For one leading dental benefits administrator, the answer has proven to be YES. 

This company engaged SKYGEN’s Enhanced Benefit Management & Analytics (EBM) services to design a managed care strategy to help its client better protect patients, educate providers, and prevent fraud, waste and abuse in its Medicare and Medicaid dental plans. 

Here’s how SKYGEN supported the solution:

• Our EBM team identified providers in need of intervention by the client 
• Our licensed clinical team of specialists developed provider education for the client to deliver
• Our EBM team helped the administrator introduce a prior authorization process and revised business rules

“Based on SKYGEN’s insights, our client is educating providers about medical necessity and following American Dental Association guidelines. We’re striving for quality of care and now we’re seeing results that clinically, are much better.”
- Chief Dental Officer, Leading Dental Benefits Administrator

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