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.
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The one who is responsible for paying your claims. It can include your employer, government agency or insurance company.
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If you are a member of a POS plan, you can choose at the time of dental service whether you would go to an in-network provider or out-of-network provider.
A pre-existing condition is a health condition that existed prior to applying for health or life insurance.
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Using medications before dental procedures is called Premedication.
Prepaid dental plans are used to fund dental care/treatment costs in advance of services, for a limited/defined population.
A primary payer is the insurer that pays a healthcare bill first.
