Unbundling of Procedures
the separating of a dental procedure into component parts with each part having a charge so that the cumulative charge of the components is greater than the total charge to patients who are not beneficiaries of a dental benefit plan for the same procedure.
tooth/teeth that have not penetrated into the oral cavity.
one-sided; pertaining to or affecting but one side.
using a procedure code which reflects a higher intensity service than would normally be used for the services delivered.
the fee that an individual dentist most frequently charges for a given dental services. (see also Customary Fee and Reasonable Fee.)
Usual, Customary and Reasonable (UCR) Plans
a dental benefit plan that determines benefits based on "Usual, Customary, and Reasonable" fee criteria. (See Usual Fee, Customary Fee, and Reasonable Fee.)
1) The extent to which the members of a covered group use a program over a stated period of time; specifically measured as a percentage determined by dividing the number of covered individuals who submitted one or more claims by the total number of covered individuals. 2) An expression of the number and types of services used by the members of a covered group over a specified period of time.
is a set of techniques used by or on behalf of purchasers of health care benefits to manage the cost of health care prior to its provision by influencing patient care decision-making through case-by-case assessments of the appropriateness of care based on accepted dental practices.
Utilization Review, statistically based
a system that examines the distribution of treatment procedures based on claims information and in order to be reasonably reliable, the application of such claims analyses of specific dentists should include data on type of practice, dentist’s experience, socioeconomic characteristics, and geographic location.