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