Delta Dental member companies include dental benefits carriers, dental carriers, health carriers, service corporations, and service plans. The majority of Delta Dental organizations are licensed as sp [..]

Information submitted by a dentist or enrollee to establish that services were provided to an enrollee, from which processing for payment to the dentist or enrollee is made. A dentist is responsible f [..]

The amount paid to Delta Dental by a group with an administrative services only (ASO) contract. An ASO

The method by which an enrollee’s healthcare service claims are reviewed before reimbursement is made. The purpose of this monitoring system is to validate the appropriateness of the provided services [..]

The method by which an enrollee’s healthcare service claims are reviewed before reimbursement is made. The purpose of this monitoring system is to validate the appropriateness of the provided services [..]

Arrangement in which enrollees must go to a network dentist to receive benefits. A capitation (HMO) program is an example of a closed panel program.  

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is federal legislation that requires employers to offer continued health insurance coverage to employees and their dependents who have had th [..]

The percentage of the costs of services paid by the patient. This is a characteristic of indemnity insurance, POS,

When a person is covered by more than one benefit plan (for example, a child who is covered by both parents’ programs), the two sets of benefits are coordinated so that no more than 100 percent of the [..]

An overview of an enrollee’s dental benefit program, usually including co-payment percentages, deductibles, maximums, and non-covered services, often used at open enrollments. Also referred to as “ben [..]