DEN 105 DENTAL OFFICE ADMINISTRATION

DENTIST AND THE PATIENT

THE TYPE OF DENTAL INSURANCE POLICY AND THE EXTENT OF THE COVERAGE.

1. fee for service
2 usual, customary and reasonable plans
3. table of allowances
4. fixed fee schedule
5. capitation programs
6. closed panel programs
7. franchise dentistry
8. direct reimbursement
9. preferred provider organization
10. health maintenance organization
11. managed care
12. individual practice association
13. union trust funds

DENTAL BENEFITS PAID FOR EACH DENTAL SERVICE OR PROCEDURE PERFORMED BY THE DENTAL PRACTITIONER INSTEAD OF BEING SALARY BASED OR CAPITATION BASED

THEY ESTABLISH A FEE SCHEDULE BASED ON THE SURVEY OF DENTAL PRACTICES WITH THE GEOGRAPHIC LOCATION AND DETERMINE THE AVERAGE CHARGED.

A LIST OF SERVICES AND PROCEDURES THAT WILL BE PAID BY THE DENTAL BENEFITS PLAN, WITH DOLLAR AMOUNT ASSIGNED TO EACH PROCEDURE

PREESTABLISHED FEES THAT ARE CHARGED BY ALL DENTISTS REGARDLESS OF GEOGRAPHICAL AREA.
IF THE NORMAL FEE CHARGED BY THE DENTAL PRACTICE IS HIGHER THAN THE FIXED FEE, THE DIFFERENCE BETWEEN THE FEES CANNOT BE CHARGED TO THE PATIENT.

A PROGRAM IN WHICH THE DENTAL PRACTICE IS PAID A SET AMOUNT FOR EACH PATIENT WHO IS ENROLLED IN THE PROGRAM.

PANELS ARE GROUPS OF DENTAL PROVIDERS WHO ARE UNDER CONTRACT WITH 3RD PARTIES TO PROVIDE DENTAL SERVICES

A METHOD THAT ALLOWS A CORPORATION TO OWN SEVERAL DENTAL PRACTICES

A METHOD OF PAYMENT THAT BYPASSES AN INSURANCE COMPANY AND IS PAID DIRECTLY FROM A FUND ESTABLISHED BY AN EMPLOYER

A CONTRACT BETWEEN A DENTAL BENEFITS PLAN ORGNIZATION AND A PROVIDER OF DENTAL CARE THAT, IN RETURN FOR THE REFERRAL OF DENTAL PATIENTS THE DENTIST WILL PROVIDE SERVICES AND PROCDURES AT A REDUCED FEE OR FEE SCHEDULE.

NETWORK OF PROVIDERS WHO WILL ACCEPT PAYMENT FOR SERVICES ON A PER CAPITA BASIS OR A LIMTED FEE SCHEDULE.

DESIGNED TO CONTAIN THE COSTS OF HEALTHCARE, INCLUDING LIMITATIONS IN ACCESS TO CARE COVERED SERVICES AND PROCEDURES AND REIMBURSEMENT AMOUNTS

LEGALLY FORMED ORGANIZATION THAT ENTERS INTO CONTRACTS WITH THE DENTAL BENEFITS PLANS TO PROVIDE SERVICES TO THE DENTAL BENEFITS