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