Solved

Match Each Term with Its Corresponding Definition

Question 22

Matching

Match each term with its corresponding definition.

Premises:

Responses:

Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment

Allowable Charges

A method of changing a reported benefits code to reflect a lower cost for the procedure

Overcoding

Legal organization of dental practitioners who enter into contracts with dental benefits plans

Nonduplication of Benefits

Billing dental benefits plans for higher-paying procedures than services actually performed

Preauthorization

Allowable services outlined by the third party dental benefits plan

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Time period when a dental benefits member can select his/her provider and type of coverage

Franchise Dentistry

Providing dental care under a common name with regional or national advertising

Individual Practice Association

The maximum amount paid for each procedure

Downcoding

Guaranteed dental coverage for 18 months after the loss of group benefit coverage

Open Enrollment

Dual coverage patients cannot receive payment for more than 100% of the covered benefit

Covered Charges

Premises:

Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment

A method of changing a reported benefits code to reflect a lower cost for the procedure

Legal organization of dental practitioners who enter into contracts with dental benefits plans

Billing dental benefits plans for higher-paying procedures than services actually performed

Allowable services outlined by the third party dental benefits plan

Time period when a dental benefits member can select his/her provider and type of coverage

Providing dental care under a common name with regional or national advertising

The maximum amount paid for each procedure

Guaranteed dental coverage for 18 months after the loss of group benefit coverage

Dual coverage patients cannot receive payment for more than 100% of the covered benefit

Responses:

Allowable Charges

Overcoding

Nonduplication of Benefits

Preauthorization

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Franchise Dentistry

Individual Practice Association

Downcoding

Open Enrollment

Covered Charges

Correct Answer:

Premises:

Responses:

Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment

A method of changing a reported benefits code to reflect a lower cost for the procedure

Legal organization of dental practitioners who enter into contracts with dental benefits plans

Billing dental benefits plans for higher-paying procedures than services actually performed

Allowable services outlined by the third party dental benefits plan

Time period when a dental benefits member can select his/her provider and type of coverage

Providing dental care under a common name with regional or national advertising

The maximum amount paid for each procedure

Guaranteed dental coverage for 18 months after the loss of group benefit coverage

Dual coverage patients cannot receive payment for more than 100% of the covered benefit