Learn More About Our
Services
Full Dental Administration
Dental Risk Company provides for the management of basic and specialised dentistry with full dental administration – such as clinical adjudication of claims measured against established protocols, capturing paper and electronic claims.
Our qualified authorisation agents clinically assess authorisation requests from providers and members for certain high-cost procedures such as specialised dentistry, in-hospital necessity and limitations on basic dentistry.
Members are advised when a procedure is not part of their benefit by the service provider, prior to any treatment proceedings. We also facilitate the payment of dental providers and sending remittances as confirmation of payment. Our client services teams are trained to validate memberships and resolve member and provider enquiries.
Risk Management
We engage in problem-solving and sound, fact-based decision-making to manage risks. Our team manages the risks of our dental network, ensuring that all providers adhere to the DRC contractual agreement and regulations. Service providers are profiled according to certain compliance and utilisation criteria, and information and action plans are presented on a quarterly basis to our clients.
Benefit design
As a fundamental factor to medical schemes, we assist in ensuring that our clients’ benefit design is in line with their members’ needs and value adding. Dental services are delivered according to the scheme’s tariffs and related to the scheme benefit.
In conjunction with benefit design, we provide client detail reporting services, which are customised and client-specific to address all operational matters that arise.
Access to a contracted provider network
With a network over 2350 signed and privately practicing dental practitioners, our providers currently service 80% of our 1.4 million lives under administration on behalf of our clients – including medical schemes, medical insurance funders and administrators. Medical scheme members have a guarantee of no out-of-pocket expense for covered procedures, provided that they visit a contracted dental service provider.
