Case Study: Dental insurer DentaQuest achieves reduced fraud and improved patient care with SAS analytics

America’s largest dental insurer uses SAS® to improve patient care while reducing costs

DentaQuest, the largest dental benefits administrator in the U.S. with 24 million members, needed to detect fraud, monitor business performance and meet tightening Centers for Medicare & Medicaid Services (CMS) quality targets — tasks that outgrew its prior Excel-based tools and required processing millions of claims records.

By deploying the SAS platform (Enterprise Miner and Enterprise Guide) DentaQuest models 50+ fraud indicators, scores provider performance, uses geomapping for state-level benchmarking and monitors quality and marketing results. The analytics made the team 2–3× more efficient, helped flag and prioritize suspicious claims, shifted patients toward preventive care to reduce costs and improve outcomes, and boosted marketing lift by as much as 30%.

DentaQuest

Dean Webb

Senior Manager of Analytics