New Tool Released That Helps Insurance Companies Combat Mexican Dental Claim Fraud
Comply Systems announced the release of DCAL (Dental Claims Adjudication Link), an online tool developed to help insurance companies process their Mexican dental claims by providing up-to-date reasonable and customary rates for procedures performed in Mexico.
Beaverton, OR, September 18, 2008 --(PR.com)-- As the trend of insured Americans traveling to Mexico for dental procedures increases so does the amount of cross border fraud. Most Americans traveling to Mexico for dental procedures do so because the dental providers in Mexico do not charge deductibles or copayments. What these patients often don't realize is that in order to recoup these costs and increase their profits, the dentist providers are actually billing insurance companies US rates instead of local Mexican rates.
A large portion of the overbilling problem comes from the billing agencies these dental providers use. These third party billers, on behalf of the dental providers, code and submit the claims in approved American Dental Association (ADA) forms and formats. In return for this service the third party billing agency takes a percentage of the money collected from the insurance companies. These third party billers know the rates applicable to the area in the US where they operate, and in an apparent effort to increase their commission, they apply those rates to the services performed by the providers in Mexico rather than the appropriate Mexican rate. This abusive billing behavior is costing insurance companies millions of dollars every year.
"Our statistics show the average Mexican dental claim is overbilled by 60%," stated Joaquin Basauri, Comply Systems, President and CEO. "By using the accurate, reasonable and customary rates DCAL provides, insurance companies will no longer be overpaying the dental providers."
"DCAL tracks possible license and TIN fraud on all claims submitted. By flagging the claims that appear to be fraudulent, the insurance company has a chance to investigate and, in some cases, deny the claim all together," stated Chris Wheat, Comply Systems, VP Software Development. "In our three-month beta we found that three out of four billing agencies used the same TIN on different dentists, and the same percentage also used different TINs on the same dentist."
About Comply Systems:
Comply Systems, LLC is a privately held company dedicated to providing the insurance industry with anti-fraud and abuse solutions as well as regulatory compliance and training tools.
www.complysystems.com
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A large portion of the overbilling problem comes from the billing agencies these dental providers use. These third party billers, on behalf of the dental providers, code and submit the claims in approved American Dental Association (ADA) forms and formats. In return for this service the third party billing agency takes a percentage of the money collected from the insurance companies. These third party billers know the rates applicable to the area in the US where they operate, and in an apparent effort to increase their commission, they apply those rates to the services performed by the providers in Mexico rather than the appropriate Mexican rate. This abusive billing behavior is costing insurance companies millions of dollars every year.
"Our statistics show the average Mexican dental claim is overbilled by 60%," stated Joaquin Basauri, Comply Systems, President and CEO. "By using the accurate, reasonable and customary rates DCAL provides, insurance companies will no longer be overpaying the dental providers."
"DCAL tracks possible license and TIN fraud on all claims submitted. By flagging the claims that appear to be fraudulent, the insurance company has a chance to investigate and, in some cases, deny the claim all together," stated Chris Wheat, Comply Systems, VP Software Development. "In our three-month beta we found that three out of four billing agencies used the same TIN on different dentists, and the same percentage also used different TINs on the same dentist."
About Comply Systems:
Comply Systems, LLC is a privately held company dedicated to providing the insurance industry with anti-fraud and abuse solutions as well as regulatory compliance and training tools.
www.complysystems.com
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Contact
Comply Systems
Joaquin Basauri
(503) 939-5594
www.complysystems.com
Joaquin Basauri
(503) 939-5594
www.complysystems.com
Contact
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