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 process of reviewing documentation related to a dentist including verification of licenses, specialty certification (if applicable), malpractice insurance, state and local licensing board actions, infection control procedures, and Occupational Safety and Health Administration (OSHA) requirements.
DDS stands for Doctor of Dental Surgery. DMD stands for Doctor of Dental Medicine.
Deductible is the amount paid out of pocket by the policy holder before an insurance starts paying.
DDPA is an organization of Delta Dental member companies. It provides the Delta Dental System with national guidelines and support.
An in-network dentist’s submission of fees for common dental procedures to his/her practice and reported frequently on dental claims.
It’s the United States Department of Health and Human Services created to protect the health of the US citizens.
DHMC is a regulatory body managing healthcare plans.
The standard diagnostic and preventative procedures include x-rays, cleaning procedures, space maintainers, oral examinations, and flouride treatment.
When an insurance company denies portions of the claimed amount, it’s called Disallowance. It can include coordination of benefits, services that are not covered, or amounts over the fee maximum.
