Dental Insurance Verification

2. Number Identifies the employer plan or group the patient belongs to
4. Year 12-month period insurance coverage follows (may not be calendar year)
6. Back Act of inputting verified benefits into the practice management system
8. Verification Method involving direct phone contact with the payer
10. Type Classification such as PPO, HMO, or Fee-for-Service
13. Covered individual other than the subscriber
14. Limitation Benefit rule that restricts coverage based on patient’s age
15. Verification Method of receiving benefit breakdown from insurance
17. Required proof of verification in the patient’s chart
18. Services Procedures the insurance will pay for
20. Limitation Rule that limits how often a service is covered (e.g., 2 per year)
21. The policyholder of the dental insurance
23. Approval required before performing certain procedures
24. Portal Online system used to verify coverage and benefits
25. Health Maintenance Organization – requires referrals and PCP selection
27. Form Standardized form used to record insurance benefit info
28. Descriptions written to explain necessity of procedures
29. Period Timeframe before certain services are eligible for coverage

1. Patient’s percentage of the allowed amount
3. Preferred Provider Organization – offers in- and out-of-network options
5. Check Step to confirm if a patient is covered on the date of service
7. Date The date coverage starts
9. Fixed dollar amount the patient pays at the visit
10. Written estimate of benefits for proposed treatment
11. Services Procedures not paid by the plan at all
12. Maximum The total amount insurance will pay in a benefit year
13. Amount the patient must pay before insurance pays
16. Breakdown Document listing covered services and limitations
19. Verification The process of confirming a patient’s active dental coverage
22. Date The date coverage ends
26. Tooth Clause Exclusion for tooth loss prior to coverage