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