Dental Payment Integrity

Section 6401 of the Affordable Care Act requires payers to establish a comprehensive compliance program as a condition processing Medicare, Medicaid or CHIP.  Dental is a key benefit in many plans and is subject to that requirement.


Claims overpayments are more than a nuisance; they are an epidemic.  Dental fraud, waste, and abuse (FWA) is often unchecked as most Payers’s dental insurance line represents 10% or less of their total business. The National Health Care Anti-Fraud Association (NHCAA) estimates $68 to $226 billion is lost annually to Fraud, Waste and Abuse (FWA).  This means up to $22.6 billion in FWA is overlooked annually. 

Context's Dental Payment Integrity analytics platform is not utilization audit software.  It goes far beyond by analyzing 100% of dental claims for: 

  • medical & technical validity
  • utilization
  • coding errors
  • patient history
  • medical necessity
  • CDT markers
  • FWA (fraud, waste, abuse)

This high volume, real-time solution is wholly managed by Context and delivered in the cloud.  The first real-time Solution available to the dental benefits industry.

Context Dental Payment Integrity is built and maintained by dental experts.  It makes dental editing and FWA accessible, affordable and scalable to support any size Payer.  Now Payers of all shapes and sizes that process dental claims can be compliant with ACA.