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