AI in Dental Insurance Adjudication

Dental Code Advisor Podcast

Join Practice Booster’s Dr. Greg Grobmyer as he talks with Dr. Dominique Fufidio about the use of Artificial Intelligence in dental insurance claims adjudication, document scanning, image interpretation, and more!

Dr. Dominique Fufidio, DDS, FAGD, is the founder and main coach at Fufidio Consulting Group (FCG). Dr. Fufidio has pioneered a unique coaching experience focused on teaching an understanding of the dental insurance claims review process and the rationale behind the decisions on the EOB. Dr. Fufidio has established herself as a successful, fee-for-service, former private practice owner, dental artificial intelligence co-creator, and top-performing dental claim reviewer and Utilization Review Director for the largest Utilization Review Agent in the United States. Now, she is on a mission to bring clinical alignment to dental providers and the dental insurance payor market, helping dental offices get paid for what they do!

Each insurance carrier is different and each reviews claims differently. Each payor selects claims to review differently and has clinical criteria that are different from one another, albeit largely similar. The concern across the industry is that the clinical documentation submitted needs to substantiate a “proof of loss” and true “medical necessity” for the treatment rendered. It is crucial to understand that the decision from the insurance payor is a benefit determination, not a treatment recommendation. The treatment recommendation is clinically yours, and yours alone. You must make the best recommendations for your patients and submit your diagnostic evidence in support.

Practice Booster is the leading resource for information on how to best utilize the CDT code set; featuring the Code Advisor database, the Insurance Solutions Newsletter, administration resources, coding support call center, and more. Visit us online at http://www.practicebooster.com.

The CDT codes are the property of the American Dental Association. Interpretations of the CDT codes in this podcast represent the opinions of our experts. Always refer to the latest CDT codes for use in your practice and contact the ADA directly for the ADA’s interpretation of the CDT codes. You are responsible for your own use of the CDT codes. For more information, refer to ADA.org.