DA117 Practice Management

1. DA117Practice Management Dental Insurance

2. Terms to know • The Plan – A contract between the employer and the Insurance company • Provider – The healthcare facility where treatment is rendered – ie- hospital, dental office

3. Carrier – The insurance company • Subscriber – Insured individual – usually the employee • Dependent – Children of the subscriber – can be step-children. Only accepted up to a certain age depending on the insurance plan or state regulations

4. Spouse – Husband or wife of the insured • Primary Insurance – Insurance of the employed • Secondary Insurance – Insurance of the spouse

5. Dual Coverage – Person is covered by more than one plan – primary insurance and secondary insurance • Coordination of Benefits – Process of determining benefit payments when more that one insurance carrier may be responsible

6. Birthday Rule – A method for choosing whether the mother’s or father’s insurance will be primary insurance for the dependent • Based on whose birthday comes first in the year • Example – Mother born February 1960 • Father born December 1955 • Mother’s insurance is billed first

7. Exclusion – Service not covered by the insurance plan • Deductible – The amount the patient must pay before the insurance makes any payment. Usually a set yearly amount

8. EOB – Explanation of benefits – Statement from the insurance company that explains how a claim was paid -

9. CDT Codes • CDT – Common dental terminology • Billing codes for dental procedures – developed by the ADA for purpose of describing dental services in a universal language. • Represented by a series of numbers • Renewed every two years to incorporate new procedures

10. Breakdown of CDT codes • First number – Represents the form of healthcare 0 – Dental • Second number represents category of dental services 1 – preventative • The remaining numbers describe the service in more detail

11. Pre-treatment Estimate • A treatment plan submitted on an insurance form to insurance company for estimation of payment before dental services are completed.

12. Electronic claims • Due to the increase in practice management software, more offices are submitting claims electronically, through the insurance company website or a clearing house • A clearing house is a company that accepts claims. Checks for errors, and submits the claim to the insurance company for payment