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