Programs/Service
Federal program that distributes funds to states for health care services provided to certain groups including aged, blind, and disabled people; those with low income; and certain members of families with dependent children
Medicaid (Title XIX)
specific procedure designated by a specific code
Single Procedure
Amount that insurance entity will pay for covered dental services described in its policy
Benefit
Plan that operated for a profit
Commercial insurance plan
Service provided by a dental provider that has been determined as generally acceptable dental practice for a specific diagnosis and treatment
Dental Necessity
Federal insurance program supported by a trust fund; provides limited funding for medically necessary dental services, such as oral/maxillofacial needs related to a medical condition for all people sixty-five years of age and older
Medicare (Title XVIII)
Identification given to a specific procedure as designated in the Codes of dental procedures and nomenclature published by the ADA
Procedure number
Legally licensed dental hygienist or dentist operating within a scope of practice
Provider
Contract between dental care providers and an employer (which eliminates the 3rd party) stating the negotiated fees for services offered to the employer's employees
Exclusive provider arrangement (EPA)
Federal program created to cover medical care for children whose families have incomes too high to qualify for state medical assistance but cannot obtain private insurance; all state participate, but some do not cover dental care
State Children Health Insurance Program (SCHIP)
Form a dental practice uses to detail the services rendered to a patient
Fee slip
Medical condition that exists prior to the person's coverage by an insurance entity. May not cover if you have this
Preexisting condition
Program in which a dental provider renders the service for which the patient's sponsor (insurance company or employer) pays
Portion of the cost of each service a patient pays
Copayment
health care program serving active-duty service members, National Guard and Reserve memebers, retirees, their families, survivors, and certain former spouses worldwide; formerly known as Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)
TRICARE
Integration of health care delivery and financing
Claims processing
program in which a dental provider renders the service for which the patient pays
Two-Party system
Amount an individual enrolled in an insurance plan must pay for covered services before the insurance entity begins paying
Deductible
Service for persons under 21 for medical, dental, and vision care paid for by Medicaid. Can stay on parents' insurance until 26
Early and periodic screening, diagnosis and treatment (EPSDT)
Patients formal request for insurance payment for a dental procedure that was rendered
Dental claim
Legal agreement between an insurance entity and group or individual
Contract
Amount a group or an individual pays to the insurance entity for coverage
Standard dental document used to file a claim or request authorization for a procedure
Dental claim form