Exam 15: Dental Insurance Processing

A new administrative dental assistant is learning to complete insurance claims.The claim she is processing is for a minor child who is covered under dental plans from both parents' employers.She asks whether you know which plan should be billed first.Using the Birthday Rule,what would you tell your colleague?

Usual,customary,or reasonable charges include criteria that may be used to establish a fee schedule.A patient asks you to explain "reasonable fee." Which of the following would be a proper explanation?

Which method of payment sidesteps the insurance company by paying directly from a fund established by an employer?

Which of the following statements is false?

Fill in the blank: _______ is the set dollar amount that the patient must pay toward treatment before the third party will consider payment.

Which of the following can aid the patient in billing the insurance company directly?

Where should copies of the Explanation of Benefits (EOB)be filed?

Which of the following statements is true?

A teenager is new to the dental office and is filling out the new patient paperwork.When he gets to the insurance section,he asks you what he should put for subscriber.You explain that:

Employers rarely change their dental coverage.A patient with the same company for 25 years will most likely have the same carrier and benefits for the duration of his/her employment.

A correctly completed dental claim form will contain all information requested for each data item.The administrative dental assistant can obtain this information from the:

Insurance companies calculate eligibility on a(n)_______ basis.

A patient states that he has dental insurance through his employer and is also covered under his wife's plan.He asks whether both plans can be used to cover the full amount of the treatment.You know that the term that describes this process is:

Maximum coverage can be described as:

When the usual fee charged by the dental practice is higher than the fee established in a(n)_______,the difference between fees cannot be charged to the patient.

A patient is in need of an expensive dental procedure.He tells you that although it would be covered at 80% now,in 1 month,it will be covered at 90% when the new benefit year begins.You know that his insurance has:

Overbilling can be described as all of the following,except:

Fill in the blank: After _______ days,review and track any unpaid dental claims.

Once submitted,a paper dental claim has a turnaround time of approximately _______,while an electronically submitted claim has a turnaround of _______.

How many data items must be entered to complete the ADA Dental Claim Form?