“Insurance is purposefully difficult … it is somehow designed to be difficult,” said Amol Nirgudkar. The Patient Prism Co-Founder and CEO echoed the sentiments - and frustrations - of many, particularly in the multi-location environment.
He was teaching a July 2023 continuing education course exploring the myriad functions of artificial intelligence in the dental industry and the ways it can smooth the patient journey while "igniting practice growth."
Mr. Nirgudkar described a “complex web” dental practices must untangle to file insurance claims and ultimately be paid for completed work. If they’re lucky.
“The statistics last year [2022] were that 11% of [dental insurance] claims were denied. 4% of claims, on top of that, were just lost,” he continued, listing inefficiencies and paperwork as common culprits. “So, you’re looking at over $4 billion in unpaid claims.” “That’s a lot of money. That’s a lot of money we’re leaving on the table.”Practices do not have to accept writing off 7% to 9% of their revenue, however.
Mr. Nirgudkar credited Zentist with asking a big question:
“Can we figure out a better way to understand claims before they are filed?”
The solution Zentist arrived at, its Remit AI software, functions as a “validation engine” - and safety net - utilizing artificial intelligence to catch errors and inconsistencies, ensuring a claim is properly constructed before it is submitted.
“We want to understand the inconsistencies in filing so we can reduce the error rate. And when we reduce the error rate, we are going to get paid. Quickly.”
Mr. Nirgudkar concluded.
