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Dental billing is one of the most detail-heavy parts of running a practice — and the jargon doesn’t make it any easier. From COB to NEA to write-offs and aging reports, there’s no shortage of terms that can trip you up (or slow you down).
Whether you’re new to billing, training someone who is, or just want to make sure your team is speaking the same language, this glossary is for you.
We’ve pulled together the most essential terminology used in day-to-day billing, and broken it down clearly.
Think of this as your desk-side cheat sheet for decoding dental billing. Bookmark it. Print it. Share it with your team. And remember: if it still feels overwhelming, Wisdom is here to help.
A
ACH (Automated Clearing House):
An electronic network that moves money between banks. Dental offices use ACH to receive insurance payments via direct deposit, known as an EFT: Electronic Funds Transfer.
Attachment Control Number (ACN)
Reference number for attachments linked to a claim.
Accounts Receivable (AR):
Total money owed to a practice from both patients and insurance, typically categorized by age (0–30, 31–60, 61–90, 90+ days). Healthy AR is critical to cash flow. Wisdom Shoutout: We monitor AR daily and escalate aging claims to reduce cash delays. With Wisdom, patient statements are sent right after insurance claims are paid. If an account goes unpaid, we follow up with calls and collection letters to help keep your receivables on track.
Adjustment:
Any change to a balance in the ledger — includes write-offs, discounts, or corrections.
Allowed Amount:
The maximum amount insurance will pay for a procedure. This may be lower than the office fee or even the contracted amount, based on plan limitations.
Attachments:
Supporting documents for claims (e.g., X-rays, perio charts, photos, clinical notes). Missing attachments are a top cause of delays. Wisdom ensures every claim includes the correct documentation by payer and procedure.
B
Balance Billing:
Charging a patient the difference between your fee and the insurance’s allowed amount. Not permitted for in-network providers.
Batch Processing:
Submitting multiple claims at once for efficiency and tracking. Wisdom processes claims in clean daily batches to catch errors early.
Benefit Breakdown:
A detailed summary of a patient’s insurance plan: deductibles, coverage %, frequency limits, and much more. Wisdom recommends a full group plan breakdown each and every benefit year for accurate estimates.
Benefit Year vs Calendar Year:
The 12-month window when benefits apply. Some plans reset January 1, others reset based on a fiscal year or plan start date.
Birthday Rule:
A COB guideline for dependents: the parent whose birthday (month and day) comes first holds the primary insurance. Wisdom confirms and documents COB—including birthday rules—during verification.
Bundling:
When insurance combines two procedures and pays for only one (e.g., separate x-rays counted as a single service).
C
Claim:
A request to insurance for payment of dental services. Must be accurate and complete to be accepted.
Claim Form:
The standardized format for submitting a claim (electronic highly recommended). Must include complete and correct data to prevent denials and/or rejections.
Claim Status Notes:
Updates in the PMS tracking a claim’s journey: submission date, follow-up actions, payer responses, and more..
Clean Claim:
A claim that’s submitted correctly the first time—no missing fields, errors, or attachments. Wisdom pre-scrubs every claim for issues before submission, minimizing rejections.
Clearinghouse:
A third-party service that transmits claims and attachments to insurance payers digitally.
COB (Coordination of Benefits):
Determines which plan pays first when a patient has multiple coverages. COB errors are a major denial cause. Wisdom verifies and records COBs up front.
D
Deductible:
The amount a patient must pay before insurance begins to cover treatment.
Denial:
A claim that was processed but not paid. Can result from coding errors, plan exclusions, or missing documentation. Wisdom tracks denial trends, fix root issues, and escalate appeals.
E
EOB (Explanation of Benefits):
A payer’s statement outlining what was paid and why. Essential for payment posting and reconciling balances.
Electronic Remittance Advice (ERA):
A third-party service that transmits claims and attachments to insurance payers digitally.
Eligibility Verification:
Checking insurance status, plan dates, and coverage before treatment. Wisdom Shoutout: We verify eligibility 48 hours ahead of appointments and store it in your PMS.
F
Fee Schedule:
A list of fixed fees a dentist agrees to charge for specific procedures under an insurance contract. Review and update in your PMS at least once a year to ensure accurate billing and estimates.
Frequency Limitation:
A plan’s limit on how often a procedure can be covered (e.g., two cleanings per year).
L
Ledger:
A patient’s transaction history, including charges, payments, and adjustments.
M
Missing Tooth Clause (MTC):
A provision in some dental insurance plans that excludes coverage for the replacement of teeth that were missing before the policy's effective date.
N
Narrative:
A clinical explanation that supports the need for treatment on a claim. Must align with SOAP notes documented in your PMS.
NEA Attachment Number:
A unique ID linking an attachment to a claim via National Electronic Attachments. DentalXchange uses DXC attachments but "FastAttach NEA" is most widely recognized by payers. At Wisdom, we use NEA consistently to track and confirm attachments are received.
P
Patient Billing:
The process of collecting what patients owe, before and after insurance payment. Our system ensures balances are communicated clearly and collected promptly. We send statements as soon as claims are paid, we follow up with letters and phone calls.
Payer ID:
A code used to route claims to the correct insurance payer via a clearinghouse.
Payment Table:
A PMS tool that estimates insurance payments for procedures based on their specific limitations and guidelines. Must be updated daily upon posting for accurate patient estimates according to a plan’s specific guidelines, downgrades and/or exclusions.
Posting:
Recording payments into the PMS accurately by date, source, and procedure. Wisdom’s posting team ensures payments and write-offs follow correct contract rules, are reconciled to the correct provider, as well as providing extremely detailed notes.
Primary Insurance:
The plan that pays first when a patient has more than one insurance policy.
Procedure Codes
- ADA Codes (CDT Codes)
Standardized codes for dental procedures published by the American Dental Association. Required for claim submission. - CDT Books
Annually updated reference books containing the official procedure codes for dental billing. Using outdated codes can result in claim rejections. - ICD-10-CM (Diagnosis Codes)
Codes used to describe patient conditions and diagnoses. While not always required for dental claims, ICD-10-CM codes are essential for medical-dental crossover billing and for documenting medical necessity. - X12 / ANSI 835
Electronic standards used in healthcare to exchange claim and remittance data between systems.
R
RCM (Revenue Cycle Management):
The full lifecycle from eligibility verification to final payment. RCM is a Wisdom specialty. We run clean, consistent billing systems that scale with you.
Remark Codes:
Codes on an EOB that explain claim decisions or denials
1. This could also be known as the section on a claim form to add in additional details such as “x-rays, clinical documentation and photos attached”. Item #35 on a claim form : [more here]
2. Remarks on an EOB are different as said above: Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing.
S
Secondary Insurance:
A second plan that pays after the primary insurance has processed a claim.
SOAP Note:
A clinical note format: Subjective (patient-reported), Objective (clinical findings), Assessment (diagnosis), Plan (treatment). Strong SOAP notes support faster payments and cleaner claims.
The Clinical Notes Blueprint
The must-have guide to documentation that sets dental teams up for 100% collections, and regulatory compliance.
T
Timely Filing Limit:
The time window (e.g., 90–180 days) within which claims must be submitted. Late = denial.
U
Unbundling
Opposite of bundling – separating procedures that are normally combined. This can trigger denials if not justified (e.g., buildups not inclusive to crown procedures).
Usual, Customary, Reasonable Fees (UCR Fees)
Benchmark fees used by insurers to decide how much to pay in a geographical area, especially for out-of-network providers. Note: UCR fees may be lower than the practice’s actual fees.
V
Verification of Benefits (VOB):
A deep dive into a patient’s plan to confirm rules, limits, and coverage levels. Wisdom's VOB templates and internal workflows help teams avoid incomplete checks.
W
Waiting Period:
The time a patient must wait before certain procedures are covered after enrolling in a plan.
Write-Off:
The portion of a fee that won’t be collected—usually due to contract agreements or plan limits. Wisdom applies write-offs only after accurate posting, avoiding phantom losses
