1.
The most that an insurance will pay for covered services per calendar or benefit/policy year
2.
A unique ID assigned to an insurance company for the purpose of transmitting claims electronically
3.
This is the the amount that a member must pay/meet before the insurance company will pay on any covered services submitted on a claim
4.
The number of procedures covered during a state period
5.
This clause means the insurance company will only pay to replace materials such as dentures, bridges, and crowns until after a specified time limit
6.
If a tooth was lost before the insurance was obtained the tooth will not be covered
7.
The length of time for which a member must be covered under the under a policy to qualify for certain benefits
8.
allows services or treatment to be reviewed for medical necessity
9.
When two insurance plans work together to pay a claim for the same person
10.
January 1st to December 31st
11.
Careington services client with processing claims
12.
Where we review claims that have been received
13.
The amount of time an insurance company allows for claims to be submitted after the date of services
14.
Not a specialist. Responsible for routine care
16.
Providers are contracted to charge no more than a specified amount or give a flat rate discount on services according to their contracted fee schedule
17.
providers charge their own fees, click which are generally higher than an INN provider’s contracted fees
18.
We do not send these to members however we can send them to Providers only – they must be listed as a General Dentist in Carelynx
