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 premium is the monthly payment patients make to insurance companies for the dental insurance plans they have enrolled in.
It refers to dentists and other dental care professionals who provide dental services.
It’s the booklet for the members of an ERISA (Employee Retirement Income Security Act of 1974) plan. ERISA is a federal law that sets minimum standards for health plans in private industry.
It’s the list of the maximum fees for each dental procedure that a specific dental program will pay.
It refers to a dental plan in which you are allowed to enroll for coverage and pay more than 50% of the cost of the insurance plan.
It’s a type of dental infection that can cause pus inside the teeth or gums. This type of infection is usually the result of untreated cavity or injury.
It’s an element used to support a device or appliance replacing one or more teeth.
Also known as LEAT or Least Expensive Alternate Treatment, it’s a provision in many dental insurance plans that states that the insurer will cover the least expensive treatment even if other better treatment is available for a patient.
Also known as maximum allowable amount, it’s the highest amount payable for covered services.
