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 a federal law that creates national standards to protect sensitive information pertaining to a patient’s health from being disclosed without his/her consent or knowledge.
A health maintenance organization (HMO) is a medical insurance group or structure that provides medical coverage to its members through a fixed network of healthcare providers for an annual fee.
The term covers the dentists who participate or agree to provide their services under a particular plan.
It refers to the services that are limited or excluded from a dental insurance plan. You are liable to pay for these services if you wish to receive them. These services are generally called optional services.
The maximum amount that a dental plan pays for the services a patient has received in a plan year or benefit year.
Medicaid is a popular federal-state public health insurance program to help low-income families or individuals with medical costs including doctor visits, hospital stays, and other medical treatment costs.
Medicare is a federal medical or health insurance program for the U.S. citizens who are either 65 years and older, and disabled. Although there is a disability criteria. The program pays for hospitalization, for stays in skilled nursing facilities, for physician’s charges, and for some associated health costs.
A network of dentists or dental professionals who agree to provide their services to the members of particular dental plan.
A group with subscribers/members in more than one state.
