As dental care becomes more complex and coding evolves rapidly, payers need smarter, faster, and more agile claims editing strategies to keep wasteful spending in check. These three pillars are key to staying ahead:
1. Continuous updates & optimizations
Stay current to stay compliant
- CDT codes and dental policies are changing annually, with over 60+ CDT changes expected in 2026 alone.
- Falling behind or missing changes leads to manual workarounds, overpayments, or even legal exposure.
- Generative AI accelerates and can automate the identification and application of new codes, guidelines, and fee schedules—reducing manual resources and keeping edits aligned with the latest policy.
The value: Reduces non-compliance, saves time & resources, and ensures policy alignment at scale.
2. Edit ideation, testing & validation
Assess before action
- New edits can cause false positives and provider abrasion if not deployed with precision.
- ‘Sandbox’ testing environments enable no-impact edit testing, A/B comparisons, and “concept bakeoffs” before edits go live.
- Ongoing data analysis identifies high-cost trends and gaps, guiding smarter edit creation.
The value: Drives impact with precision, forecasts disruption, lessens provider friction, and builds confidence in deployment.
3. Auditability & workflow management
Track activity, promote transparency
- Strong workflow management, version control, and audit trails help plans explain and manage changes.
- Enhances collaboration across teams—from claims ops to policy and network management.
- Transparency and traceability are essential for compliance, internal alignment, and cross-team execution.
The value: Boosts internal efficiency, trust, cross-functional decision-making.
The bottom line
Modern editing strategies powered by AI, testing & validation, and transparent workflows are the path to reduced errors and greater savings for dental plans. Dental plans that adopt these tools not only avoid costly disruption—they gain a stronger foundation in payment integrity, improved provider relations, and streamlined operations.
View and share the infographic below, or learn more about how Shift Payment Integrity can help modernize your dental claims editing strategy.
