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