How PAI Makes Benefits Better for Large Dental Carrier

In 2023, PAI welcomed a large dental carrier to our book of business. With a quick implementation timeline and stringent carrier requirements, PAI was able to adeptly move all hands on deck to provide streamlined service to the carrier’s 25,000 existing PPO, HMO and Medicare subscribers

PAI’s customer service, technology, claims and account management teams have pulled together to make benefits better for the carrier, dental providers and their members.

Customer Service

PAI’s customer service team was quickly able to adjust staffing and expand call center hours to accommodate west coast dental providers and members without any compromise in service.
Each month, PAI’s dedicated customer service team has been able to meet or exceed the following performance standards: 

• Average speed of answer (ASA) less than 30 seconds
• Abandon rate of less than 4%.
• First call resolution – 95% of calls are resolved on the first call.
• 98% of calls are closed within 5 business days with 100% of calls closed within 10 business days.

PAI’s partnership with an industry leader in providing dental claim review services has proved to be integral in the dental carrier’s extensive pre-authorization requirements. Each month, PAI has been able to deliver timely service for pre-authorizations:

• More than 98% of pre-authorization requests received are processed within 14 days for non-emergencies. 
• For emergencies, more than 98% of expedited pre-authorization requests are processed within 72 hours.

Technology

PAI created a customized claims handling and eligibility intake approach to meet the carrier’s compliance needs. A separate claims system was implemented to segregate data as required and expand on dental claims processing needs.
PAI’s IT team was able to identify and accommodate complex eligibility data presented by the carrier to minimize any disruption to new and existing members.

PAI’s web-based user portal has given providers, members and employers access to information 24 hours a day / 7 days a week. Members are able to email customer service, print or request an ID card on demand, find a network provider, review claims and access forms. 

Claims

The claims team has also taken a personalized approach by using a dedicated group of processors for the carrier to expedite the carrier’s unique needs. Each member has over 15 years’ experience in the industry to ensure claims are paid correctly in a timely manner. PAI is committed to meet the following standards:

• Greater than 92% of clean claims processed in 14 calendar days.
• Greater than 95% of all claims processed in 30 calendar days and 100% of all claims processed in 60 calendar days.

Account Management

With a dedicated IT project manager and a dedicated account manager, PAI has been able to ensure all teams are effectively communicating and continuously strive to provide the best service possible. This customized approach and personalized touch is one way PAI makes benefits better.