![]() Bīad faith insurance practices: The failure to deal with a beneficiary of a dental benefit plan fairly and in good faith or an activity which impairs the right of the beneficiary to receive the appropriate benefit of a dental benefits plan or to receive them in a timely manner. A post-treatment record review or clinical examination to verify information reported on claims. See claim form.Īudit: An examination of records or accounts to check their accuracy. An appeal can be filed by a healthcare provider or a patient in an attempt to recover reimbursement from a third-party payer such as a private insurance company.Īssignment of benefits: A procedure whereby a beneficiary/patient authorizes the administrator of the program to forward payment for a covered procedure directly to the treating dentist.Īttending dentist’s statement: An obsolete term for the ADA Dental Claim Form. Efforts in the United States directed toward the development of ISO standards are channeled through ANSI.Īny willing provider: Legislation that requires managed care organizations (MCOs), such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) to contract with any providers who are willing to meet the terms of the contract.Īppeal: A formal request that an insurer review denied or unpaid claims for services or supplies provided. The results of ISO technical work are published as International Standards. ![]() ISO (International Organization for Standardization) is a worldwide federation of national standards bodies. The ADA (American Dental Association) is a national standards development organization accredited by ANSI. ANSI (American National Standards Institute) is the national organization established for the purpose of accrediting and coordinating product standards development activities in the United States. See dental benefit organization: third-party administrator.Īllowable charge: The maximum dollar amount on which benefit payment is based for each dental procedure as calculated by the third-party payer.Īlternate benefit: A provision in a dental plan contract that allows the third-party payer to determine the benefit based on an alternative procedure that is generally less expensive than the one provided or proposed.ĪNSI/ADA/ISO: Acronyms for organizations that administer or develop national and international standards. This frequently includes all insurance company services (actuarial services, underwriting, benefit description, etc.) except assumption of risk.Īdministrator: One who manages or directs a dental benefit program on behalf of the program’s sponsor. Click a letter to jump to that section.)Ī | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z AĪdministrative costs: Overhead expenses incurred in the operation of a dental benefit program, exclusive of costs of dental services provided.Īdministrative services only (ASO): An arrangement under which a third party, for a fee, processes claims and handles paperwork for a self-funded group. (Words and terms in bold are defined within this glossary. ![]() New dentists and staff, however, may not be as familiar – and over time new terms come into use and old terms are revised for clarity. Many terms are familiar, especially to experienced individuals. There are many terms used daily by dentists and their staff in the course of delivering care to patients, maintaining patient records and preparing claims.
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