Page 28 - Bulletin Vol 25 No 2 - May-Aug 2020 - 9-2-20.pub

Article | Insurance continued

look at every claim. So, the majority are adjudicated by an algorithm that will move the
process along but inevitably marks some legitimate claims as rejected and some fraudulent

claims as approved. The frustration on our part results from the necessity to cut down on
fraud, waste and abuse by the minority.

Enter Artificial Intelligence. Through AI automation, the process of “touchless” claims
eliminates any human intervention. This is done through automated reporting,
capturing, auditing and communication. Radiographs and photos are the primary diagnostic
tools we use to justify treatment as well as the primary evidence on which insurers assess
claims. It’s also the area in dentistry where AI can deliver the most immediate results by
way of computer vision. In fact, AI systems based on computer vision technology for

radiographic analysis are on their way to surpassing the diagnostic abilities of humans.

Oral imaging diagnostic systems with “computer vision” AI will soon be able to deliver highly
accurate results at “light speed” and bring the clarity of fact to dental insurance. AI will help
doctors get quicker and fairer evaluations from insurance companies. It will also help protect
insurance companies from dishonest doctors in an expedient manner. AI can detect
instances of resubmission fraud in which dentists submit a single image depicting a
particular pathology multiple times or submit the same image to more than one insurer. AI

can also flag potential instances of over-diagnosis and diagnostic error. AI will
evaluate all radiographs and/or photos accompanying every claim. Evaluation results can
be used to assess a claim’s likelihood of approval, allowing insurance companies to rapidly
and intelligently determine which claims need to be manually reviewed and which should be
fast-tracked for approval.

The bottom line is the use of Artificial Intelligence in Dentistry is on the horizon. In fact, the
COVID-19 pandemic has accelerated the adoption of AI in the healthcare industry. Just as

“9-11” accelerated technology for national security, the current crisis has accelerated the
adoption of AI due to changes in the workforce. For the majority of us it will aid in
diagnosing more accurately and getting our claims adjudicated faster. For that “Bad Apple”
minority…you’ve been warned.

Dr. Porcelli is Past Chair and a member of the
NYSDA Council on Dental Benefit Programs for
13 years. Currently he serves as the New York
State representative on the ADA Council on
Dental Benefit Programs.

28 | Nassau County Dental Society  www.nassaudental.org