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Test your basic knowledge |
Dental Insurance Vocab
Start Test
Study First
Subjects
:
health-sciences
,
dentistry
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. Treatment plan submitted to the benefit carrier for review and estimate of payment before services are rendered.
Assignment of Benefits
Reasonable and customary (R&C) plan
Predetermination
Overcoding
2. Dental benefits program in Which benefits are provided only if care is rendered by institutional and professional providers with whom the plan contracts.
25. Exclusive Provider Organization (EPO) plan
Nonparticipating dentist
Fee for service plan
Birthday Rule
3. Reporting a more complex or more expensive procedure that was actually performed. Fraudulent.
Overcoding
Open Panel System
Fee Schedule
Reasonable and customary (R&C) plan
4. Requiring payment in full from the patient/responsible party for all services rendered.
Direct Billing
Covered services
Assignment of Benefits
Effective Date
5. Dental services that's payable under the terms of the benefit program.
27. Explanation of benefits EOB
16. Current Dental Terminology (CDT)
Allowed amount
Covered services
6. Amount or percentage of the dentist's fee that the patient is obligated to pay.
Copayment
National Provider Identifier (NPI)
Enrollee
Allowed amount
7. Person who files a claim for reimbursement of covered costs (the dentist & practice)
Claimant
Direct Reimbursement
Premium
Cafeteria Plan
8. Amount charged by a dental benefits carrier for coverage.
Premium
Claim Form
Usual fee
Reimbursement
9. Employer's or organization's self funded program for reimbursing covered individuals based on a percentage of the amount spent for dental care.
Balance Billing
Effective Date
Direct Reimbursement
Allowed amount
10. Person or company who manages or directs a dental benefits program on behalf of the program's sponsor
Exclusions
Balance Billing
Claimant
Benefit administrator
11. Reference manual by the ADA that includes the Codes on Dental Procedures and Nomenclature and other instructions tools for reporting dental services to dental benefits plan and administrators.
Preexisting condition
Balance Billing
16. Current Dental Terminology (CDT)
Reasonable and customary (R&C) plan
12. Federal assistance program; provides payment for medical care from the federal government.
Medicaid
25. Exclusive Provider Organization (EPO) plan
Preferred provider organization (PPO)
Usual fee
13. Benefit carrier that has initial responsibility for benefit payment when a patient is covered by tow or more carriers.
Copayment
Limitations
Primary Carrier
Usual fee
14. Requiring the patient to pay any difference between the dentist's actual fee and the amount reimbursed by the benefits carrier(insurance company) - in addition to any co-payment - deductible - or maximum.
Overcoding
Reasonable and customary (R&C) plan
Usual fee
Balance Billing
15. Dental benefits program in which a dentists are paid for each covered service rendered to an eligible enrollee.
Fee for service plan
Capitation
Reimbursement
16. Current Dental Terminology (CDT)
16. Method of determining the primary carrier for dependent children who are covered more than one dental plan. With this method - the primary payer is the parent with the earlier date of birth by month and day - without regard to the year of birth.
Usual fee
Birthday Rule
Assignment of Benefits
HIPAA
17. Organization that bears the financial risk for the cost of defined categories or services for a defined group of policy holders or beneficiaries.
Insurer
Approved Services
Dependents
Nonparticipating dentist
18. Fee a dentist most frequently charges for a given dental service.
Usual fee
Cafeteria Plan
Covered services
Open enrollment
19. Dental services that are not covered under a dental benefits program--excluded from plan
Maximum allowable benefit (MAB)
Birthday Rule
Reimbursement
Exclusions
20. Dental benefits program that allows 1) enrollees to receive dental treatment from any licensed dentist; 2) licensed dentist to participate; and 3) payment of benefits to either the enrollee or the dentist.
Open Panel System
Balance Billing
Copayment
Premium
21. Individuals - such as spouse and children - who are legally and contractually eligible for benefits under a subscriber's dental benefits contract.
Reasonable and customary (R&C) plan
Expiration Date
Benefit administrator
Dependents
22. Period between employment or enrollment in a dental program and the date the enrollee became eligible for benefits.
Copayment
25. Exclusive Provider Organization (EPO) plan
Waiting period
Direct Billing
23. Federal Law intended to improve access to health insurance - limit fraud and abused - and control administrative costs.
Table of allowance plan
Effective Date
Copayment
HIPAA
24. Date an individual and/or dependents become eligible for benefits under a dental benefits contract.
Maximum allowable benefit (MAB)
Claimant
Effective Date
COBRA
25. Fee for service/services determined to be representative of the fees charged by dentist in a specific region or geographical area.
Deductible
Balance Billing
Direct Reimbursement
Customary fee
26. Dental benefits program that lists an assigned amount payable for each covered service; generally amount is below the average fee charged by dentists- AKA schedule of allowance.
COBRA
Approved Services
Table of allowance plan
Reimbursement
27. Health care coverage system which employers offer a list of options for health care benefits.
Limitations
Cafeteria Plan
25. Exclusive Provider Organization (EPO) plan
Medicaid
28. Maximum dollar amount the benefit carrier allows for each dental procedure
Allowed amount
Premium
Subscriber
Waiting period
29. Restrictions stated in a dental benefits contract that limit the scope of coverage.
Enrollee
Fee Schedule
Primary Carrier
Limitations
30. Paper form used to request payment or predetermination for patients covered by a dental benefits program.
27. Explanation of benefits EOB
Capitation
Claim Form
Fee for service plan
31. Dental benefits program in which enrollees can receive benefits only when services are provided by dentists who have signed an agreement with the benefit plan to provide treatment to eligible patients.
Customary fee
Closed Panel System
Reimbursement
Approved Services
32. Detailed statement of a processed claim showing the patient - provider - procedure codes - date of service - the carrier's payment - and the patient's copayment.
27. Explanation of benefits EOB
HIPAA
Open Panel System
Preferred provider organization (PPO)
33. Benefits delivery system in which a dentist contracts with the programs's sponsor or administrator to provide all or most of the dental services covered under the program in return for a fixed monthly payment per covered person. Also called a DHMO (d
Copayment
Fee for service plan
Covered services
Capitation
34. Employee or participant who is certified by the company who receives benefit coverage.
Maximum allowable benefit (MAB)
Closed Panel System
National Provider Identifier (NPI)
Subscriber
35. Unique identification number. NPI part of HIPAA
National Provider Identifier (NPI)
Effective Date
Claim Form
Preexisting condition
36. Fee for service dental benefits program in which payment of benefits is based on reasonable and customary fee criteria.
Copayment
Reasonable and customary (R&C) plan
Benefit year
Direct Billing
37. 12 month period of the dental contract (not always a calendar year)
Reimbursement
Closed Panel System
COBRA
Benefit year
38. Consolidated omnibus budget reconciliation act which allows a person to temporarily maintain insurance coverage even if he/she loses job.
Closed Panel System
COBRA
Direct Reimbursement
Waiting period
39. Highest total dollar amount a dental benefits program pays toward the cost of dental care incurred by an individual or family in a specified period such as a calendar year - a contract year or lifetime.
Birthday Rule
Subscriber
Maximum allowable benefit (MAB)
Fee for service plan
40. Authorization by the enrollee/patient for the dental benefits carrier to make payment for covered services directly to the treating dentist
Allowed amount
Birthday Rule
Assignment of Benefits
Waiting period
41. Dentist who does not have a contract agreement with benefits carrier.
Effective Date
HIPAA
Nonparticipating dentist
Waiting period
42. Dental benefits program in which participating dentists agree to a discounted fee schedule for services rendered to patients.
Nonparticipating dentist
Preferred provider organization (PPO)
Usual fee
Table of allowance plan
43. Services covered by a benefit plan. Payment for these services may be subject to plan maximums - limitations - and deductibles
Cafeteria Plan
Approved Services
Usual fee
Fee Schedule
44. List of charges established by or agreed to by a dentist for specific dental services listed by ADA procedure codes.
Fee Schedule
Closed Panel System
Premium
Benefit administrator
45. Date on which the dental benefits or contract expires or date an individual ceases to be eligible for benefits.
Capitation
Direct Billing
Reimbursement
Expiration Date
46. Person who is eligible for benefits under a dental benefits contract; AKA member - insured individual - participant - beneficiary.
Benefit administrator
Primary Carrier
Capitation
Enrollee
47. Period during which employees or group members can enroll in health care programs.
Open enrollment
Predetermination
Fee for service plan
16. Current Dental Terminology (CDT)
48. Amount of dental expenses a covered person must pay before the dental plan benefits begin.
Reimbursement
Cafeteria Plan
Premium
Deductible
49. Oral health condition that existed before a person enrolled in a dental program.
Direct Billing
Premium
Open enrollment
Preexisting condition
50. Payment made by a benefit carrier or third party payer to an enrollee or to a dentist on behalf of the enrollee as repayment of fees charged.
Subscriber
Reimbursement
Premium
Approved Services