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