Navigating Insurance Company Audits, Complaints, and Investigations

About this Seminar

Dental insurance audits are becoming increasingly common across Canada, and the stakes for dental professionals have never been higher. This practical, compliance-focused course equips dentists and dental team members with the knowledge needed to respond to insurance company inquiries, navigate insurance audits, respond effectively to complaints or investigations, and most importantly, prevent issues before they arise. The course outlines the audit process and highlights what nsurers look for when reviewing claims, what triggers an audit, common pitfalls leading to an audit, and the possible outcomes of an audit. Participants will learn strategies to ensure their records support the treatment provided, minimize administrative risk, and promote smooth interactions with insurance carriers.

Learning Objectives:

Understand the audit process, triggers, and how to respond to an audit.

Ensure clinical records and documentation clearly supports the treatment provided and procedure codes submitted to insurers.

Learn how to reduce administrative inconsistencies and errors in claims submission.

Minimize the risk of an audit and negative outcome.

Presenters

Dr. Christopher Swayze

About Dr. Christopher Swayze

Dr. Chris Swayze graduated from the Faculty of Dentistry, University of Western Ontario, in 1993; obtained his MBA for Science and Technology from Queen’s University in 2000; and in 2012 received the Osgoode Certificate in Health Law from Osgoode Hall Law School. He joined the staff of the Royal College of Dental Surgeons of Ontario (RCDSO), in 2002, where he worked for more than 16 years. While at the RCDSO, Dr. Swayze held numerous positions, including as Manager, Reports, in the Professional Conduct and Regulatory Affairs Department, the RCDSO’s Inquires Complaints and Reports process, Quality Assurance, ADR/mediation, discipline, remediation, and on working groups developing guidelines and standards of practice. In 2019, Dr. Swayze left the RCDSO and joined the University of Toronto, Faculty of Dentistry, as Director, Continuing Dental Education. He is a member of the Dean's Senior Leadership Team, on several CSA Group IPAC Standards Committees, including the national standard CAN/CSA Z314 Technical Committee - Medical Device Reprocessing, an examiner and invigilator for the National Dental Examining Board of Canada (NDEB), a member of the International Association for Health Professions Education (AMEE) CPD Committee, and a member of IPAC Canada. He is also a Fellow of The Pierre Fauchard Academy, The American College of Dentists, and The International College of Dentists.