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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. 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
Exclusions
27. Explanation of benefits EOB
Dependents
2. Reporting a more complex or more expensive procedure that was actually performed. Fraudulent.
Capitation
Maximum allowable benefit (MAB)
Overcoding
Preexisting condition
3. Treatment plan submitted to the benefit carrier for review and estimate of payment before services are rendered.
Predetermination
25. Exclusive Provider Organization (EPO) plan
Open Panel System
Allowed amount
4. Person who files a claim for reimbursement of covered costs (the dentist & practice)
Benefit year
Claimant
Fee for service plan
Closed Panel System
5. Maximum dollar amount the benefit carrier allows for each dental procedure
Allowed amount
Direct Reimbursement
Table of allowance plan
Predetermination
6. Health care coverage system which employers offer a list of options for health care benefits.
Exclusions
Waiting period
Cafeteria Plan
27. Explanation of benefits EOB
7. Oral health condition that existed before a person enrolled in a dental program.
Deductible
Insurer
Subscriber
Preexisting condition
8. Detailed statement of a processed claim showing the patient - provider - procedure codes - date of service - the carrier's payment - and the patient's copayment.
Primary Carrier
27. Explanation of benefits EOB
Maximum allowable benefit (MAB)
Customary fee
9. Restrictions stated in a dental benefits contract that limit the scope of coverage.
Balance Billing
Limitations
Covered services
Usual fee
10. Amount or percentage of the dentist's fee that the patient is obligated to pay.
Copayment
Waiting period
HIPAA
Nonparticipating dentist
11. Consolidated omnibus budget reconciliation act which allows a person to temporarily maintain insurance coverage even if he/she loses job.
COBRA
HIPAA
Premium
16. Current Dental Terminology (CDT)
12. List of charges established by or agreed to by a dentist for specific dental services listed by ADA procedure codes.
Usual fee
Fee Schedule
Limitations
Reasonable and customary (R&C) plan
13. Amount of dental expenses a covered person must pay before the dental plan benefits begin.
Closed Panel System
COBRA
Deductible
Open Panel System
14. 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.
Birthday Rule
Closed Panel System
Direct Reimbursement
Fee for service plan
15. Federal Law intended to improve access to health insurance - limit fraud and abused - and control administrative costs.
Expiration Date
HIPAA
Premium
Usual fee
16. Person or company who manages or directs a dental benefits program on behalf of the program's sponsor
Benefit administrator
Waiting period
Open enrollment
Nonparticipating dentist
17. Services covered by a benefit plan. Payment for these services may be subject to plan maximums - limitations - and deductibles
Approved Services
Cafeteria Plan
Fee Schedule
Fee for service plan
18. Dental benefits program in which a dentists are paid for each covered service rendered to an eligible enrollee.
Fee for service plan
Preferred provider organization (PPO)
Deductible
Preexisting condition
19. 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.
16. Current Dental Terminology (CDT)
Open enrollment
Closed Panel System
Limitations
20. 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.
Reasonable and customary (R&C) plan
Birthday Rule
Open enrollment
Benefit administrator
21. Period during which employees or group members can enroll in health care programs.
Premium
Benefit administrator
Open enrollment
Effective Date
22. Authorization by the enrollee/patient for the dental benefits carrier to make payment for covered services directly to the treating dentist
Deductible
Capitation
Assignment of Benefits
Customary fee
23. Date an individual and/or dependents become eligible for benefits under a dental benefits contract.
Effective Date
Allowed amount
Dependents
Nonparticipating dentist
24. 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
Maximum allowable benefit (MAB)
Allowed amount
Capitation
Customary fee
25. Dental benefits program in which participating dentists agree to a discounted fee schedule for services rendered to patients.
Preferred provider organization (PPO)
Primary Carrier
Cafeteria Plan
Medicaid
26. Dental services that's payable under the terms of the benefit program.
Insurer
Premium
Covered services
Primary Carrier
27. Date on which the dental benefits or contract expires or date an individual ceases to be eligible for benefits.
Birthday Rule
Expiration Date
Maximum allowable benefit (MAB)
Claimant
28. Fee for service dental benefits program in which payment of benefits is based on reasonable and customary fee criteria.
Preexisting condition
Direct Reimbursement
Primary Carrier
Reasonable and customary (R&C) plan
29. Fee for service/services determined to be representative of the fees charged by dentist in a specific region or geographical area.
Claim Form
Claimant
Customary fee
Approved Services
30. Employee or participant who is certified by the company who receives benefit coverage.
Benefit year
Direct Reimbursement
Benefit administrator
Subscriber
31. Federal assistance program; provides payment for medical care from the federal government.
Medicaid
Allowed amount
Copayment
Deductible
32. 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.
Expiration Date
Reimbursement
Exclusions
National Provider Identifier (NPI)
33. Organization that bears the financial risk for the cost of defined categories or services for a defined group of policy holders or beneficiaries.
Claimant
Approved Services
Insurer
COBRA
34. Amount charged by a dental benefits carrier for coverage.
Copayment
Limitations
Covered services
Premium
35. Employer's or organization's self funded program for reimbursing covered individuals based on a percentage of the amount spent for dental care.
Direct Reimbursement
Claim Form
Premium
Medicaid
36. Paper form used to request payment or predetermination for patients covered by a dental benefits program.
Cafeteria Plan
HIPAA
Claim Form
Fee Schedule
37. Dental benefits program in Which benefits are provided only if care is rendered by institutional and professional providers with whom the plan contracts.
Table of allowance plan
Birthday Rule
25. Exclusive Provider Organization (EPO) plan
Covered services
38. Unique identification number. NPI part of HIPAA
National Provider Identifier (NPI)
Reimbursement
Preferred provider organization (PPO)
Assignment of Benefits
39. Period between employment or enrollment in a dental program and the date the enrollee became eligible for benefits.
Waiting period
Copayment
Premium
Effective Date
40. Benefit carrier that has initial responsibility for benefit payment when a patient is covered by tow or more carriers.
COBRA
Fee for service plan
Primary Carrier
Preexisting condition
41. 12 month period of the dental contract (not always a calendar year)
Fee for service plan
Capitation
27. Explanation of benefits EOB
Benefit year
42. 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.
Covered services
Customary fee
Balance Billing
Limitations
43. Requiring payment in full from the patient/responsible party for all services rendered.
Subscriber
Direct Billing
Approved Services
Cafeteria Plan
44. 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.
Table of allowance plan
Premium
Limitations
Approved Services
45. Dentist who does not have a contract agreement with benefits carrier.
Direct Billing
Primary Carrier
Table of allowance plan
Nonparticipating dentist
46. Fee a dentist most frequently charges for a given dental service.
Cafeteria Plan
Usual fee
Benefit administrator
Table of allowance plan
47. Individuals - such as spouse and children - who are legally and contractually eligible for benefits under a subscriber's dental benefits contract.
Predetermination
Primary Carrier
Dependents
Direct Reimbursement
48. Dental services that are not covered under a dental benefits program--excluded from plan
Benefit administrator
Premium
Exclusions
Assignment of Benefits
49. 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.
Claim Form
Premium
Maximum allowable benefit (MAB)
COBRA
50. Person who is eligible for benefits under a dental benefits contract; AKA member - insured individual - participant - beneficiary.
Table of allowance plan
Fee for service plan
COBRA
Enrollee