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