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 provision in dual coverage cases which describes the way the secondary insurer calculates its pportion of payment.
Dentists or dental professionals who do not participate in a particular dental program to provide their services are non-participating dentists.
It covers the dentists who have not participated or enrolled or agreed to be a part of a particular program/organization to provide their service to its members.
The cost that a patient pays which is not covered by his/her health insurance plan. It may include a copayment, a deductible, and any amount exceeding the plan’s maximum and optional services not covered by the plan.
It covers the dentists who participate or agree to provide their services under a particular program/plan. See In-network.
Preauthorization, also known as Prior authorization or prior approval, confirms a patient’s medical insurance coverage. Preauthorization allows a dentist to know if a particular treatment is covered by the patient’s insurance plan or not.
The percentage of the recommended treatment covered by the insurance company. It includes other specifics like how the insurance company will pay a claim and when dentist or the patient will receive repayment.
A dental condition that existed before you enrolled in a dental insurance plan. Generally, a standard dental program do not exclude pre-existing conditions.
A dental fee-for-service plan that allows you to visit any dentist of your choice and provides financial incentives if you visit any in-network dentists with low service fees.
