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.
An appeal is a form of request made to insurer to review denied or unpaid claims. Either you or your dentist can file an appeal to get reimbursed from insurance company.
A category of dental services that includes fillings, extractions, root canals, and root planning. These services are also called Class II, Group II or Type B services.
Images of upper and lower, front and back teeth used by dentists to check for decay, whether the teeth line up, bone loss from gum disease and infection. Bitewings are usually provided in sets of tooth or four x-rays.
The common terms used for tooth decay.
A request to get reimbursed under a dental insurance plan. A claim lists all the services rendered, itemized costs, date of service, etc. Payment is made using this information.
When you discuss or conult dental care or services you require with your dentist.
The rates insurance companies pay their in-network dental professionals for the services they provide. These rates are mentioned in the insurers’ contract with providers.
The process of replacing a part or all of the crown of a tooth whose purpose is to provide a base for retention of an indirectly fabricated crown.
The portion of the cost you pay for the dental services you receive.
