The Delta Dental plans of Indiana, Kentucky, Michigan, New Mexico, North Carolina, Ohio and Tennessee have established the Focused Review program to help monitor claims and ensure accurate processing and contract fulfillment.
Focused Review is a time in which a provider’s claims for a select group of procedure codes are manually reviewed to ensure appropriate documentation is being submitted and group contract guidelines are being met.
Of the very few providers who are placed on Focused Review, the majority are randomly selected. An even smaller number of providers may be on Focused Review because a claims analysis shows a statistical difference from their peers, or a complaint has been filed against them.
Providers selected for Focused Review will receive a packet of information, including a list of procedure codes requiring additional documentation and how to submit claims to the Focused Review department. Review this information carefully to ensure a smooth process and timely claims payment.