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COH-financing terms

dental care financing terms

benefit amount insurance entity will pay for covered dental services described in its policy
Children Health Insurance Program federal program cover medical care for kids whose families incomes too high to qualify for state medical assistance but can't obtain private insurance, all state participate but some don't cover dental
claims processing entering procedures rendered and determining whether payment will be approved or denied
commercial insurance plan plan that operates for a profit
contract legal agreement b/t an insurance entity and a group/individual
deductible amount an individual enrolled in an insurance plan must pay for covered services before insurance entity begins paying
dental claim patient's formal request for insurance payment for a dental procedure that was rendered
dental claim form standard dental document used to file a claim or request authorization for a procedure
managed care integration of health care delivery and financing
medicaid federal program that distributes funds to states for health care services provided to certain groups including aged, blind, disabled people, those w/ low incomes and certain members of families w/ dependent kids
medicare federal insurance program supported by trust fund, provides limited funding for medically necessary dental services, all people 65+
preexisting condition medical condition that exists prior to person's coverage by insurance entity
premium amount a group or individual pays to insurance for coverage
procedure # ID given to specific procedure as designated in Codes on Dental Procedures and Nomenclature published by ADA
provider legally licensed DH or dentist operating w/in scope of practice
dental claim form standard dental document used to file a claim or request authorization for procedure
dental necessity service provided by dental provider that has been determined as generally acceptable dental practice for a specific diagnosis and tx
early and periodic screening, dx, tx service for persons under 21 for medical, dental, vision, paid for Medicaid
exclusive provider arrangement contract b/t dental care providers and employer stating the negotiated fees for services offered to employers employees
explanation of benefits form sent to patient and provider explaining approval or denial of payment for procedures rendered
fee slip form a dental practice uses to detail the services rendered a patient
prepaid group practice large group of dental providers contracted to provide services to groups of patients
single procedure specific procedure designated by a specific code
sound natural teeth either primary or permanent teeth that have adequate hard/soft tissue support
three party system program in which dental provider renders service for which patient's sponsor (insurance, employer) pays
TRICARE (aka Civilian Health and Medical Program of Uniformed Services) health care program serving active-duty service members, National Guard and Reserve members, retirees, their families, survivors, certain former spouses worldwide,
two party system program in which a dental provider renders service for which patient pays
fee for service fee scale is developed for all services provided by dental provider and payment is then developed for service rendered, most common payment metho din US
capitation dental provider contracts w/ program to provide all/most dental services to program's subscribers in return for payment on per capita basis
Barter system dental provider and patient negotiate payment by exchanging goods or services w/o utilizing money
encounter payment is based on an office visit and is always same regardless of service rendered
Created by: 100000001783325