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DAA 102 CHAPTER 14

Across
An organization that bears the financial risk for the cost of defined categories or services for a specific group policy holders or beneficiaries.
The Consolidated Omnibus Budget Reconciliation Act, which allows a person to temporarily maintain insurance coverage, even if he or she loses his or her job.
The employee or participant who is certified by the company or organization providing the dental program as eligible to receive benefit coverage.
Restrictions stated in a dental benefits contract that a limit the scope of coverage; such as restrictions may include age limits for certain procedures, waiting periods before benefits are available, and payment frequency for certain services.
A paper formed used to request payment or predetermination for the treatment cost of patients covered by a dental benefits program.
The benefits carrier that has the initial responsibility for benefit payment when a patient is covered by two or more carriers. The primary carrier processes and pays claims to the full extent of the patient's coverage.
A list of charges established or agreed to by a dentist for specific dental services.
A federal assistance program established as Title XIX under social security Act 165, that provides payment for medical and dental care for certain low income individuals and families.
Individuals such as a spouse and children who are legally and contractually eligible for benefits under the subscribers dental benefits contract.
The company or organization that contracts with a benefits carrier to administer their dental program.
Down
The fee that a dentist most frequently charges for a given dental service.
The fee for a service or services determined to be representative of the fee charged by the dentists in a specific region or geographic area.
A benefit delivery system in which a dentist or practice contract with a program's sponsor or administrator to provide all or most of the dental services covered under the program in return for a fixed monthly or quarterly payment per covered person
The amount or percentage of the fee for a covered service that the patient is obligated to pay.
A method used to determine the order of liability. When dependent children are covered by more than one dental plan.
Service or treatments that are not covered by a dental benefit program.
A person is eligible for benefits under dental benefits contract.
The amount charged by a dental benefits carrier for coverage or for administration of benefits for a specified time.