| A | B |
|---|
| Allowed Charges | The maximum amount that an insurer will consider to pay for a service, including any amount that the patient will be responsible for paying. |
| Audit | An official inspection of an individual's or organization's accounts, typically by an independent body. |
| Balance Billing | Is the practice of a healthcare provider billing a patient for the difference between what the patient's health insurance chooses to reimburse and what the provider chooses to charge. |
| Benefit Payment | amount paid by the dental benefits plan. |
| Benefit Services | Services that are by the dental benefits plan. |
| Birthday Rule | Method used to determine which parent is considered the primary provider of a child’s dental coverage; the rule establishes that the parent whose birth comes first during the year is the primary provider. |
| Brand Name | A name given to a product by its manufacturer that becomes part of the product's identity. |
| Capitation | The annual fee paid to a health care practice by each participant in a health plan. |
| Claim | Method used to request payment or authorization for treatment. |
| Claims Payment Fraud | Changing or manipulating of information on a claim form that results in payment of a lower benefits to the treating dentist. |
| Claims Reporting Fraud | Changing or manipulating of information (by the dentist) on claims form that results in payment of a high benefits by the dental benefits plan. |
| Closed Panel (program) | programs that dictate to patients where they can receive their dental treatment. |
| Collection Process | A company or agency that is in the business of recovering money that is owed on delinquent accounts. |
| Consolidated Omnibus Budget Reconciliation Act (COBRA): | Legislation that mandates guaranteed medical and dental coverage for a period of 18 months after loss of group benefits coverage. |
| Consumer | One who may receive or is receiving dental service; the term is also used in health care legislation and programs as a reference to someone who is never a practitioner or is not associated in any direct or indirect way with the supplying or provision of dental services. |
| Copayment | A payment made by a beneficiary (especially for health services) in addition to that made by an insurer. |
| Corporate Dentistry | Type of dental facilities that are owned and operated by companies for the purpose of providing dental care to their employees and dependents. |
| Covered Charges | Allowable services that are outlined in dental benefits plan contracts, fee schedules, or tables of allowance, as determined by the dental provider and for, in whole or in part, by the third party dental benefits plan. |
| Credit Report | : A tool used to gather credit information. |
| Current Dental Terminology (CDT): | Terms and codes standardized by the ADA for the purpose of consistency in reporting dental services and procedures to dental benefits plans. |
| Deductible | Service fee that the patient is responsible for paying before the third party will consider payment of additional services. |
| Dental Benefit Plan | Plan that provides dental service to an enrollee in exchange for a fixed, periodic payment made in advance of the dental service. |
| Dental Supply House | Company that sells several different manufactures products and goods. |
| Dependents | Persons who are covered under another person’s dental benefits policy. |
| Direct Reimbursement | Payment plan that allows an organization to be self-funded for the purpose of providing dental benefits. |
| Divided Payment Plan | Plan in which payments are divided according to the length of treatment. |
| Downcoding | A practice of third-party payers in which the benefits code has been changed to a less complex or lower cost procedure than was reported. |
| Duel Choice Program | An insurance policy (benefit plan) that provides the eligible individual the choice of an alternative dental benefit program or a traditional dental benefit program. |
| Established Patient | Denotes someone who has been seen by a physician or member of a health care group within a 3-year period. |
| Exclusions | The option in a dental benefits program to exclude dental service procedures. |
| Exclusive Provider Organization (EPO | A dental benefits plan or program that will cover dental services only if are provided by an intuitional or professional provider with whom the dental benefit plan has a contact. |
| Family Deductible | A deductible that can be satisfied when combined deductible of the family have been met. |
| Fee for Service | Method of payment that compensates the dentist according to individual services and procedures. |
| Fee Schedule | List of charges for dental services and procedures. |
| Franchise Dentistry | Method or providing dental care under a common name. |
| Generic Name | A term referring to any drug marketed under its chemical name without advertising. |
| Hazardous Communication Program | Method of dealing with hazardous material |
| Individual Practice Association (IPA) | Legally formed organization that enters into contracts with dental benefits plans to provide services to enrollees in the benefits plan. |
| Inventory Control Room | Is a system the encompasses all aspects of managing a company's inventories; purchasing, shipping, receiving, tracking, warehousing and storage, turnover, and reordering. |
| Manufacturer | A person or company that makes goods for sale. |
| Material Safety Data Sheet (MSDS) | Components of a hazardous communication Program that contain information about a product. |
| Maximum Coverage | The most coverage an insurance company will provide during a specific period. |
| Nonduplication of Benefits | Stipulation that applies if a subscriber is covered by more than one benefit plan. |
| Open Enrollment | Period of time when member of a dental benefits program has the option of selecting the type of coverage and the provider of dental services. |
| Overcoding | Billing of dental benefits plans for procedures that results in higher payments than are justified by the service or procedure that was actually performed. |
| Preauthorization | Certification by a dental benefits plan that a pretreatment plan has been authorized for payment in accordance with the patient’s group policy. |
| Skip Tracing | Process for locating a person who has moved and not left a forward address. |
| Tracking System | Is generally a system capable of rendering virtual space to a human observer while tracking the observer's coordinates. |
| Eligibility Date | The date an individual and dependents become eligible for benefits under a dental benefits contract |
| Vendor | A person or company whose principal product lines are office supplies and equipment. |
