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Predetermination

An administrative procedure that may require the dentist to submit a treatment plan to the third party before treatment is begun. The third party usually returns the treatment plan indicating one or more of the following: patient's eligibility, guarantee of eligibility period, covered services, benefit amounts payable, application of appropriate deductibles, co-payment and/or maximum limitation. Under some programs. predetermination by the third party is required when covered charges are expected to exceed a certain amount, such as $200.

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