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 dental services, prescription drugs, and procedures, covered in your insurance plan. Any dental insurance plan does not cover everything. Even for the covered services, you may need to pay a deductible, co-payment or co-insurance.
It’s the clinical examination used to find if there is any sign of dental diseases, malformation or injury. It helps a dental professional to recognize the appropriate and most suitable treatment for you or refer you to other dentist if required.
Any professional who is officially licensed or certified to provide dental services within the scope of that license or certification. It can include a dentist, dental hygienist, dental assistant, etc.
A dental plan similar to DHMOs and DPPOs. You can receive dental care only from in-network dentists. Only emergency services are covered in case of out-of-network dentists. Under a DEPO plan, you can visit specialists without a referral. However, the charges will be covered only if the specialist is in the network.
A Dental HMO plan provides discounted dental care through a network of dentists. In detail, a DHMO plan is a type of managed care plan that offers comprehensive and less expensive dental care to individuals and families through a network of qualified dentists. A DHMO plan, also called a Capitation plan, is considered as least expensive dental insurance plan available.
A device specifically designed to be placed within or on the mandibular or maxillary bone through surgery. It’s a form of dental replacement.
A dental indemnity plan allows you to visit any dentist of your choice as the plan has no pre-sepcified network of dentists. The plan usually has an annual deductible. It’s also called fee-for-service plan.
You pay a monthly/yearly premium to a dental insurance company to be covered under a dental plan or denta insurance policy. The insurer pays some or all of your dental care costs in return. You may also need to pay other charges such as deductibles, co-pays, or co-insurance as part of the plan. DPPOs, DHMOs, DEPOs, DPOS, and Dental Indemnity Plans are some of the most common dental plans.
It’s a method of financing the cost of dental services before receiving them.
