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.
It’s the reimbursement level for a dental procedure regulated by a dental plan administrator.
It refers to the essentially appropriate treatment and follow-up care as prescribed by dentist.
The dental care charges/costs not covered by your insurer. For some covered services, the insurer is not responsible for the entire cost and you have to bear the charges not covered by your plan.
The dental care services not covered in your dental insurance plan. If you receive no-covered services, you will be liable to pay the entire treatment cost.
It’s repetitive. Remove it.
A type of dental plan which allows you to receive dental care from any dentist because it allows any dentist or dental professionals to participate to offer their services. Open panel plans are also known as freedom of choice plans.
The plan benefits you receive from the dentists don’t take your insurance plan.
An out-of-pocket maximum is the most a health insurance policyholder will pay each year for covered healthcare expenses.
Asking for higher than actual charges for a dental service is called overbilling.
