First, let’s set the record straight: Artificial intelligence, or AI, in the dental industry doesn’t mean your dentist will be replaced by a robot. (Although, yes, a robot dentist might be kind of awesome.)
Instead, for both dentists and insurance companies, AI technology will bring accuracy, consistency and efficiency to a new level. And the good news is that this futuristic technology is here now.
What is artificial intelligence, anyway?
While the technology is complicated, the idea behind it is simple: AI uses computer software to analyze large sets of information and find patterns in them. As it gathers more and more information, it gradually learns to assess situations and then make informed decisions or predict outcomes.
So what does artificial intelligence mean for the dental industry?
When a patient visits the dentist for to receive treatment for a dental issue, two things must occur. First, the dentist must determine the appropriate procedure and submit a claim to the insurance company. Second, the insurance company must determine whether the dentist’s claim is valid and the procedure will be covered.
For both dentists and insurers, inconsistency and disagreements during this process can cause frustration and delays, which can in turn lead to frustration and delays in treatment for your clients.
Here’s how AI can help.
AI can make quick, impartial decisions
In many cases, AI can analyze data far more quickly and accurately than a person can, and can act as a second opinion. One of the most promising applications for AI is analyzing oral imagery, or as they’re more commonly known, x‑rays.
“When dentists make diagnostic decisions, there are clear-cut rules,” said Dr. Daniel Croley, Delta Dental’s chief dental officer. “There are clinical rules that say, ‘This is decay,’ or ‘This is periodontal disease.’ However, that’s also open to some interpretation, and dentists have different levels of aggression when they want to treat disease.”
AI analyzes x‑rays to bring consistency and reliability to decision making, Croley said.
AI can help eliminate fraud
Certainly, most dentists are ethical and want to provide only appropriate treatment for their patients. Still, insurers have to watch out for those few bad actors who abuse the system to help ensure dental care remains safe, effective, available and affordable for your clients.
For questionable claims, insurance companies have teams of dentists available to review claims and the accompanying x‑rays for fraud. But the volume of claims insurers receive (Delta Dental processed more than 34 million claims in 2020), makes manually reviewing every claim for fraud impossible.
AI can help dramatically expand insurers’ ability to detect fraud. By being able to examine and compare thousands of x‑rays, AI can quickly detect abuse such as resubmission fraud, where a dentist uses the same x‑ray to submit multiple claims, and overdiagnosis. (It can also identify honest errors, such as when a dentist mistakenly submits the wrong image.)
Because AI can retain vast amounts of information and compare it instantly, Croley said, it can identify potential fraud much more easily than a person can.
“It will be able to not only to review reports like we do to determine how a certain procedure was done,” Croley said, “but it can also look at the x‑ray that was submitted with it and say, ‘Hey, this was submitted last year for another patient.’ AI will be able to recognize that and learn as it as it goes along.”
It’s for this reason that Croley believes fraud detection is emerging as one of the leading uses for AI in dentistry right now.
This ability to detect fraud quickly and accurately is a win for everyone. It protects insurance companies from dishonest dentists and conversely ensures that ethical dentists are treated fairly by insurers when they submit claims. This trust and efficiency will in turn inspire confidence for your clients.
“We only want to have quality dentists and dentists who deliver quality care in our network,” Croley said. “What AI will help us do is to monitor our network very closely, develop appropriate oversight plans and then take action when necessary. And I think how that manifests for our members is more confidence in the dentists that are endorsed by Delta Dental as network providers.”
The future for AI in dental insurance looks bright
AI is still an emerging and evolving technology, so its full promise hasn’t been realized, and there are still challenges that must be overcome. For instance, many states require a licensed dentist to be involved in any review of a dental claim.
“There’s still a lot of rules around benefit determination at the state level,” Croley said, “but once regulation starts to keep up with the technology, we may see some of that evolve from a regulatory standpoint.”
Still, Croley is optimistic about AI’s potential and what it will mean for your clients. He believes AI will enable Delta Dental to improve the quality of treatment that its dentists deliver and members receive. This in turn will increase members’ confidence in Delta Dental.
“This is what I’m excited about,” Croley said.” People trust us to do the right thing, and AI will enhance the level of trust that they have with us.”