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Claims administration

Full dental claims paying administration

Core Five Solutions offers full dental claims paying administration services. Through our extensive knowledge of the dental marketplace, our strategic partnerships and our administrative services, we are able to offer a full spectrum of dental program and claims administration options. claims processing
Since all of our services are provided by in-house resources, equipment and staff, our quality process and cost efficiencies are second to none. We are able to offer any piece of the claims administration process as needed by our clients. 

  • Implementation of any plan design, network affiliation or group size
  • Import of legacy claims data for take over business
  • Fully HIPAA compliant
  • Total reporting capabilities for real-time review of the entire life of a claim
  • Claims adjudication, repricing, audit and review
  • Predeterminations
  • Aggressive and adaptable clinical edits to ensure proper processing by CDT code
  • Regular claims audits – both prepay and postpay
  • Ability to customize layout and content of EOB and EOP

Claims success story

Core Five Solutions successfully designed, implemented and administered a new individual indemnity dental product with an embedded discount network layer for a large national benefit company. This product launch allowed the client to achieve broader success in the individual dental market while achieving cost savings with Core Five Solutions as the administrator and claims payer.