It’s the process of submitting a claim through multiple edits to ensure appropriate payment. When a claim is processed this way without any human interaction, it’s called auto-adjudication.
It includes general administrative services such as billing, claims processing, and other expenses.
Allowable charge is the fees on which plan deductibles, coinsurance, and maximums percentage are based, and dentists are reimbursed for the services rendered as per their agreement with insurer.
It’s the total cost that needs to be paid by you (patient) and member company.
The program allows you to enroll in either a traditional or an alternative dental benefit program.
It’s the date you and your dependents are eligible for the plan benefits. It’s also known as effective date.
The date beyond which you and your dependents are not eligible to avail the benefits of your dental insurance plan.
Extending eligibility for benefits for covered services as per your plan. It’s usually done to ensure the completion of treatment begun before the extended eligibility expires.
The process of removing a tooth.
Deductible for the combined expenses of all covered family members. Let’s assume that as per your family insurance plan, your family deductible is $100 and the individual deductible is $50. If two family members use their individual deductible, the limit of the family deductible is reached. So, other family members covered in the insurance plan who need dental treatment would not have any deductible for that calendar year.
It’s the process of restoring lost tooth structure by using materials including metal, alloy, plastic or porcelain.
It’s your employee repayment account which is primarily funded with your designated salary reductions. You and your dependents are paid for your health care. The funds in this account are considered as non-taxable benefit.
The tissue that surrounds and support your teeth.
