Miscellaneous Terms
The dental provider and patient exchange goods and services without using money.
WHAT IS THE BARTER SYSTEM?
Amount that an insurance entity will pay for covered dental services described in its policy.
What is a Benefit?
Charged based on a fee scale for all covered services.
Most common method used in the U.S.
What is Fee-for-Service Plan?
Form a dental practice uses to detail the services rendered to a patient.
What is a Fee Slip?
Integration of health care delivery and financing.
What is Managed Care?
The amount that an insurance entity will pay for covered dental services described in its policy.
What is a Benefit?
Portion of the cost of each service a patient pays
What is a Copayment?
A plan that basically pays for each care encounter regardless of the service provider
What is an Encounter Fee Plan?
A medical condition that exists prior to a person's coverage by an insurance entity.
What is a Pre-existing Condition?
Organizations that provide comprehensive health care to enrolled individuals & families in a specified region by participating M.D.'s & financed by fied periodic payments.
What is a Health Maintenance Organization (HMO)?
Codes on Dental Procedures and Nomenclature of ADA which are updated every 5 years.
What are CDT - Current Dental Terminology Codes?
Amount an individual enrolled in an insurance plan must pay for covered services before the insurance entity begin paying.
What is a Deductible?
Federal medical insurance program for people age 65 or older, people under age 65 w/ certain disabilities.
What is Medicare (Title XVIII)?
Amount a group or an individual pays to the insurance entity for coverage.
What is a Premium?
Dental provider contracts w/ a 3rd party to provide all or most of the services to a specified group of people in return for a fixed monthly payment.
What is a Capitation Plan?
Service provided by a dental provider that has been determined as a generally acceptable dental practice for a specific diagnosis or treatment.
What is Dental Necessity?
Patients formal request for insurance payment for dental procedure that was rendered.
What is a Dental Claim?
Federal program that traditionally distribute funds to states for medical & dental care provided to certain groups of people. I.e., low income
What is Medicaid (Title XIX)?
Identification given to a specific procedure as designated in the Codes on Dental Procedures & Nomenclature published by the ADA.
What is a Procedure Number?
Health care program serving active-duty service members, National Guard & Reserve members, retirees, their families, etc.
What is Tricare?
Service for persons under the age of 21 for medical, dental & vision, paid for by Medicaid.
What is the Early & Periodic Screening, Diagnosis & Treatment (EPSDT)?
Average dentist fee per services in the immediate local region
What is Usual, Customary, Reasonable (UCR) fee?
Organizations practitioners contract with dentists to provide dental care services for lower than average fees.
What is a Preferred Provider Organization (PPO's)?
A legally licensed dental hygienist or dentist operating within a scope of practice.
What is a Provider?
A federal program that provides medical care for children whose families have income too high to qualify for state medical assistance but cannot obtain private insurance.
What is the Children Health Insurance Program (CHIP)?