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