Dental claims audits are effective way to ensure systems and processes are in place to optimize claims payment performance. Dental claims audits may or may not require an onsite examination of audit samples. Organizations who elect to conduct dental claims audits often pair them with audits of other coverages like medical, prescription drug or vision to receive an overall assessment of third-party administration effectiveness.

Depending on the audit firm, audit approach, and technology used, dental claims audits can expose a wide variety of claims adjudication issues and/or weaknesses in areas such as exceptions to covered services, services provided to ineligible participants, timely filing limits, deductible application, coinsurance application, and maximum benefits.