Page 27 - Bulletin Vol 25 No 2 - May-Aug 2020 - 9-2-20.pub

Article | Insurance

Artificial Intelligence in Dentistry and Dental

Claims

By Eugene G. Porcelli, DDS

The phrase “Artificial Intelligence (AI)” congers up all sorts of imagery. From computers
taking over our daily lives in such Sci Fi thrillers as Terminator and iRobot to the more
practical smart home systems learning our daily routine and controlling home lights and
temperature. An area you may not have thought about is in your dental practice. AI can
help with diagnosis but also in insurance claim adjudication and fraud detection.

Software powered by AI automates routine tasks that are typically completed by humans
and does so with superhuman speed and precision. AI technology can learn to make

insights and find patterns in complex systems and vast amounts of data that no person
could ever do.

AI applications are under development to aid in diagnosis and practice management. By
scanning tens of thousands of radiographic images, the systems can learn to diagnose
even the smallest changes in bone height and tooth density at levels not seen by the
human eye. Such developments will lead to earlier and more accurate diagnoses. The
technology isn’t here yet, but it’s being developed and is just a matter of time until it is

available. Once perfected, it can help the practitioner by accurately diagnosing issues
they may have missed, thereby increasing production but, perhaps even more importantly,
preventing a lawsuit from undiagnosed disease.

What is here, at least in its infancy, is the use of AI by the insurance industry. As much as
we might hate to admit it, a lot of our patients’ treatment choices are driven by their dental
plan benefits. We all know the frustration of delays due to pre-determinations, or even
worse, the “need for more information.” In the current process, claims go through multiple
employees that severely affect the quality of the process. As dentists, we look at claims

processing and see a system that, at best, slows us down and, at worst, aims to cheat us.
But if we step back and look at the bigger picture, especially from the view of the insurer,
the bureaucratic black hole we see in claims processing starts to look like an unfortunate
but essential industry safeguard. The vast majority of dentists are honest, trying to do
what is right for their patients. However, there are a few “bad apples” who over treat, or
worse, purposely try to commit fraud. It is this minority that forces insurers to slow down
the process for all of us when adjudicating and analyzing claim submissions. Large
insurers may get forty million claims a year. They don’t have the manpower to physically

Nassau County Dental Society  (516) 227-1112 | 27