PROCESS MEXICAN DENTAL CLAIMS WITH DCAL™
Dental Claims Adjudication Link - DCAL™A secure and innovative web-based system that allows the claims handler to quickly and efficiently adjudicate dental claims originating in Mexico. This simple, efficient, and reliable tool provides up-to-date reasonable and customary rates - by dental code - for the specific geographical zone where the dental service was provided.
DCAL™ helps ensure that our customers and partners are not defrauded by paying inflated costs for services received by their members in Mexico. All procedures are listed under treatment codes as set by the American Dental Association.
Adding Claims
Our intuitive claims form makes it easy to add new claims to the system. The standard form includes inputs for your internal claim number, billing area, billing agency, dentist information, and dental procedures provided by ADA code. Each section of the form includes instructional tooltips. If your organization wants to track additional information we will create a customized form at no additional cost.
Zone Selector
Our reasonable and customary rates are broken down by geographical locations. Our easy to use zone selector allows you to quickly select the appropriate zone by state and city.
Claim View
View the details of any claim. The claim details screen features hover-over tooltips for all ADA codes, these helpful tips provide the claims handler with the ADA category and description of the code.
Fraud Detection
DCAL™ tracks licenses and Tax ID numbers across the platform. When a member company enters a claim, the system alerts the user if the same license or Tax ID number has been used for a different provider in previous claims. Likewise, the system informs the user if the provider has utilized a different license or Tax ID number.
Member companies benefit from cross-referencing from a universe of tens of thousands of claims. If the information corresponds to a claim from the user's company, the system provides the claim number for reference. If the alert identifies a claim from another member company, the user can contact Comply Systems to request contact information for a member of the other company's Special Investigations Unit or claims department.
Claims Grid
The real-time interactive claims grid allows your organization to easily look at all claims in the system. It allows you to add and remove columns, filter by multiple columns, sort, and export the data to Excel.
Export Options
Your claim data is not locked in our system. We believe you should be able to export your data easily as needed. Our tools allow you to export all claims, claims matching specific search criteria, or a specific claim in csv, Excel, or pdf format.
The Excel export option creates an Excel file that features a frozen header row, filtering for each column, column specific formatting, and a footer row with formula based totals.
User Administration
Our user administration makes adding and editing users easy. You can assign user specific permission, revoke access, and reset passwords.
Comprehensive Reporting
Understanding your Mexican dental claim data is important. The system comes with 12 standard reports that allow you to visualize every aspect of your claim data.
Standard reports included:
- Executive Summary
- Quantity Of Claims By Billing Agency
- Top 10 Codes By Quantity
- Invoices
Overbilling / Savings
- Total By Billing Agency
- Claim Average By Billing Agency
- Top 10 Codes - Average
- Top 10 Codes - Total
- Total By Procedure Category
- Average By Procedure Category
- Total By User
- Total By Zone
