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.
A network of dentists and dental care professionals who agree to provide their dental care services to the members of a dental insurance plan under the terms of contract.
The expenses that are allowed to be paid from Health Saving Accounts (HSAs) are Qualified Dental Expenses.
A self-funded plan, also known as a self-insured plan, is a health plan where the employer assumes the risk for paying health claims as opposed to purchasing an insurance policy from an insurance carrier, where the insurer assumes the risk.
The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service.
