Despite manual and data-driven mitigation efforts, fraud, waste and abuse continue to affect roughly 5% of dental insurance claims–– costing payers billions annually. Pearl Protect® helps dental insurers overcome those losses with a patented AI solution that automatically identifies doctored and duplicative radiographic claims evidence.
Assessing every claim submitted both historically and in real time, Pearl Protect® offers a comprehensive and high-precision defense against ongoing FWA while equipping insurers to recuperate payments on fraudulent past claims.
Detecting image-based dental submission fraud requires a complex, interwoven array of AI capabilities, combining predictive analytics, natural language processing, generative algorithms. deep unsupervised learning, and state-of-the-art in CV image recognition techniques.
No matter what method is used to obscure an image's duplicative nature, Pearl Protect® can spot it––even when the image has been manipulated using professional photo-editing software.