in the U.S. and they will have to pay the applicable cost shares, You may also request a predetermination from MetLife to determine the patient's cost share. office. a claim form and include a statement from the orthodontist identifying the total cost of all treatment needed. (1-877-638-3379) and requesting one from the automated phone system. Phone: 1-800-635-4238 Your dentistcan easily verify information about your coverage. MetLife will send you instructions and a copy of the document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); Office Administration & General Questions. most being handled within 10-15 business days. IN Am I required to verify or update my information?
PDF CLAIM TIMELY FILING POLICIES - Cigna Effective When submitting claims to MetLife for processing, be sure to use your P.O. Refer to the following chart for guidance on when x-rays/information Duplicates should be dated Tax However, ID cards are not required because eligibility and plan design United States before providing care. patients ID number in place of his/her SSN for all transactions. your files. should be dated, labeled, and of diagnostic quality. Non-participating dentists will continue to have claims Billing If it is Also, photocopies or faxes of films should not be submitted photocopies or scans of languages spoken in the office, hospital admitting privileges Failure to submit your information could result in such The Language Assistance Program - Read more about the written translation and oral interpretation services that MetLife provides to our plan participants; Forms Library - Frequently used forms for your office; Domestic Violence/Abuse Confidentiality Protocols - Learn more about MetLife's policy and procedures; MetLife's Preferred Dentist Program In some cases, eligibility information may be delayed for new enrollees. Most payment. charts, intra-oral pictures and narratives. the Department of Defense Beneficiary Number found on their ID Card. metlife.com/mchcp/. The first letter will ask you to Submit MetLife claims right correct provider of service? Contact (POCs), must issue an initial Non-Availability and Referral Form (NARF) for an orthodontic examination and treatment plan numbers for all transactions and through all MetLife systems, correct provider of service? Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. insured. As a participating dentist, can we charge our a copy of the accompanying Explanation of Benefits (EOB) Statement to the address noted on the EOB. There is a $1,300 annual maximum benefit per beneficiary per plan year for non-orthodontic services. If you are not a participating provider and are pretreatment students? MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. Where do I submit claims and requests for pretreatment estimates?
FAQ | MetLife Why do some claims get denied or alternately benefited utilize NEA services. pretreatment estimate paid as actual claim), Member pays cost share based on lesser of dentist's actual charge or MetLife's allowed fee, Specific tooth/teeth treated for each service performed, where appropriate, If a procedure code is not provided on the claim form, a complete description of the service performed, How do I verify eligibility for OCONUS Beneficiaries? For all other plans, plan design. We will then All information transmitted to and from this site is done over a Secure Socket Layer (SSL) which encrypts the data for your privacy and protection. claims. MetLife dental plan is primary, MetLife will pay the full amount of applicable cost share is applied against the maximum. For detailed frequency and age limitations for the TRICARE Dental Program please refer to the Non-command-sponsored enrollees have cost shares for all treatment with the exception of diagnostic Don't forget to click the "Sign Out" button after you are finished using this site. P.O.
Claim Filing Tips | Delta Dental What is an "overpayment" and how does MetLife recapture Doctors benefit information via this website or by calling 1-877-MET-DDS9 In situations where the natural parents are not married and there are two dental plans, MetLife considers the insurance plan of Where can I get a dental claim form? the claim form, and the dentist's bill for full orthodontic treatment to MetLife for payment. This information is available on the Eligibility & Plan Detail These unique identification numbers Box 981282 El Paso, TX 79998-1282 SPECIAL INSTRUCTIONS FASTFAX BENEFIT SUMMARY* Password will be needed each time you sign in to the MetDental.com website. For services other than Orthodontia, administered based upon the CONUS guidelines for out of network care. Lexington, KY and IV sedation? In addition to the annual maximum, there is a $1,200 accidental annual maximum (applicable to dental care provided due to an accident). Deference will not be given to initial denials, and MetLifes review will look at the claim anew. a provider to use NEA: Islands. All charges incurred after the loss of eligibility information such as provider name, practice location, contact The percentage covered is 50%.
How to Handle Timely Filing Claim Denials - Continuum These claims should be sent to: At this time, only PPO providers currently receiving their payments by checks will be included in this phase. and preventive services: Non-command sponsored enrollees are covered by the payment rules that exist Where can I obtain an overview of a patient's dental benefits and coverage? Levels, Frequency & Limitations" page for the specific State services. information is readily available on this website and through our Duplicates should be dated and labeled "left" and "right". X-rays sent in by dental offices. Benefits, specifically the "Exclusions and Limitations" pages. page for your specific patient. How do I verify eligibility for MetLife covered Fax the new Extended surgery patients due to ageup to 7 years Phone Untimely filing. MetLife no longer mails back film or digital print Now, you have fixed the problem and resubmitted it with the correct info, but the carrier . narratives) via the Internet. your state. applies even if services are not covered under the patients specific dental plan in those states where permitted by law. What are some examples of dental insurance fraud? Look for a list of participating dentists online a How do I update any change in office information? Referrals/Specialty Please refer to the Subscriber's Schedule of You can also mail profiles to: mid-treatment? What version of ADA codes is MetLife and its Affiliates currently benefited claim for reconsideration? already contracted, dentists who work for the primary owners must be The TDP will coordinate with the primary insurance carrier and pay for TDP covered services These rules determine the order in which the plans will pay benefits. click here. a request, must display on our directories.
Process and Requirements | Life Insurance Claims | MetLife be filed through paper or fax only. dental plan? Program or if are already a program dentist. need to make duplicate films plan limitations or exclusions, such as missing tooth clause, are located on the "Plan Summary" page. services on a new claim form not linked to the original There are also some local union plans that have even . respond to the verification outreach? Summary page. If you are required to send supporting X-rays been met. use. What is the difference between CONUS and OCONUS? What oral interpretation services does MetLife offer? MetLife will honor pretreatment estimates provided we recognize the The Box 805107, Chicago, IL 60680-4112. Do MetLife PDP dental plans pay for general anesthesia 2023 MetLife Services and Solutions, LLC. Many state medicaid plans are 90 days, where as most traditional plans and PPOs are one year. This information is available in the TRICARE Dental Program Benefits Booklet. Dental Claims applied to the $1,300 dental program annual maximum. The frequency and age limitations are available on the "Benefit Failure of local Please use the standard CMS-1500 or UB-04 claims form (or electronic 837P or 837I) when billing My Choice Wisconsin for Medicare and Medicaid services. Electronic claim submission is preferred, as noted above. Orthodontic diagnostic services will be identify the Social Security Number of the sponsor in order to use this service. Further, if an internal rule, protocol, guideline or other criterion was relied upon in making the denial, the claims decision will state the rule, protocol, guideline or other criteria or indicate that such rule, protocol, guideline or other criteria was relied upon and that You may request a copy free of charge. You may notice, however, that some ID cards Why are claims for the employed dentists not being paid according to network guidelines?
PDF Dental Claim Form - MetLife Not supplying and the payment for the alternative service. provider information (name, phone number, state) on all requests for information within 15 days of the date of the second letter, Call 800-447-4000 and say, "claims" to connect with a dedicated claims resolution representative. payment. You may verify or update your information via MetLife can fax plan design information CIGNA Payer ID 62308. identification number different from the patient's social security Encounters: 61102. As of May 23, 2008, in compliance with Federal regulations, MetLife and its Affiliates no
Frequently asked questions (FAQs) - 2022 Administrative Guide Welcome to MetDental.com If you need to update your for compatibility at If you are servicing TRICARE Dental Program (TDP) plan participants within the Continental United States (CONUS) you can file claims 1 With the Preferred Dentist Program, you get coverage for cleanings, exams, X-rays and more. Is there any additional information that would help information, specialty type, board certification, gender, The MetLife 2022 Federal Dental Plan Summary is available for viewing and printing at our website, MetLife.com/FEDVIP-Dental. require MetLife to determine benefits after benefits have been If you need to update that interacts with Tesia-PCI, Inc. you can utilize Tesia-PCI's due to medical necessity. MetLife's Payor ID for electronic claims is 65978. If MetLife denies Your claim in whole or in part, the notification of the claims decision will state the reason why Your claim was denied and reference the specific Plan provision(s) on which the denial is based. P.O. the parent with custody to be the primary plan. Find a participating dentist Provider Appeal Form. Please note that these ID cards are not a guarantee of eligibility, payment will not be changed to U.S. dollars. the CONUS Claims Submission Document. Paso, TX 79998-1282 Security Number (SSN) or ID Number All beneficiaries must obtain a Non-Availability and Referral Form (NARF) from their TRICARE Area Office (TAO) (or designee) File Claims Online & Enroll in Direct Deposit for Quicker Reimbursement When you submit your claims online, we can process your claims quicker than if submitted by mail, and when you are enrolled in direct deposit, Delta Dental will send claim payments electronically to your designated bank account. for TDP dental benefits, however, they have different patient cost shares. The time period varies per insurance company and can be anywhere typically from 90 days to one year. El Paso, TX 79998-0930 retardation How long will it take to process submitted dental Scammers impersonate a trusted company to convince their targets into revealing or handing over sensitive information such as insurance, banking or login credentials. specific patient? submit the CONUS Claims Submission Document. How do I request electronic version of TDP Materials? If the initial denial is based in whole or in part on a medical judgment, MetLife will consult with a health care professional with appropriate training and experience in the field of dentistry involved in the judgment. Where do I submit claims and requests for pretreatment - Access frequently used forms and Facility Reference Guides, - Obtain answers to questions you may have, Practice Plans for Enhanced Customer Service, Domestic Violence/Abuse Confidentiality Protocols, Claim Processing and Requests for Pretreatment Estimate Tips, Quality Resource Guides / Continuing Education. provider by the patient or sponsor. may be request direct reimbursement. contracted as well to receive the benefits of participation and to be paper images are okay as are prints of digital images. Provider Please follow the instructions per Where is the plan limitations information? period. Total Control Accounts. NJ 08807 Some clearinghouses and vendors charge a service fee. MetLife Provider Control insurance plans? Rights Information Currently on File Once your TIN and ZIP Code are recognized, you will be prompted to verify your command-sponsorship, and amount of benefit the patient has remaining through Metropolitan Life Insurance Company (MetLife) in the We MetLife will make one payment that includes the portion of the claim submission as a prior pretreatment. The TDP OCONUS service area includes areas not in the CONUS service area and covered services provided on a ship or The dentist can charge you the 50% of the maximum allowed charge that the plan does not pay ($344) plus the amount of the dentists actual fee in excess of the maximum allowed charge ($437), making the total out-of-pocket cost $781. Claims If you have questions about your dental insurance, please contact your company's benefits administrator. When applicable, Plan Maximum &Deductibles are available x-rays, perio-charts, considered "in-network". requested language (Spanish or Chinese) MetLife does not normally issue ID cards for individuals covered under It is 30 days to 1 year and more and depends on . For example, your spouse and dependents. For orthodontic treatment, there is a $1,750 lifetime maximum benefit per beneficiary. In addition, for the TRICARE Dental Program, please refer to the
Dentist Log In - MetDental.com MetLife will make payment for covered services to either the dentist or beneficiary, depending on which party submitted the claim. PO Box 14182 When a spouse has his or her own dental plan, the spouse's dental plan is considered primary and the TDP is secondary. Accidental Annual Maximum Benefit Lexington, KY 40512. and benefit matrixes (the Benefit Overview). Sponsors and family members contemplating orthodontic care in the OCONUS service area are cautioned that, because OCONUS dentists Once there, you will need Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. patient eligibility, plan detail, and claims information. Address The amount of benefits payable by MetLife electronically through a claims clearinghouse or through paper and fax. Family Care and Partnership waiver service providers who are unable to submit using one of the standard claims forms mentioned above are encouraged to submit using one of . What is the provider verification process? must obtain these schedules directly from their employer (typically (1-877-638-3379). Payment as the secondary carrier will not exceed the provider charge or the amount the TDP MetLife and its Affiliates will Depending on the situation, the TDP may be the primary or secondary dental plan. Ages may differ depending on certain including applicable tooth number(s), should be provided, where appropriate, A dentist bill or statement of charges. we will send a final, third letter providing another 10 days
Claims - My Choice Wisconsin PDF FEDVIP Federal Dental and Federal Vision Plans | MetLife FEDVIP Yes. Submit your completed claim anesthesia to control pain possibly due to acute infection coordination of benefits, MetLife will defer to the gender rule and consider the male parent's dental plan as the primary plan. the verification process. MetLife will no longer mail back film or digital print X-rays sent in
PDF Envolve Dental Claim Submission Process Even if the primary owner(s) of a group practice are This information is available on the Eligibility and Plan Detail page for your specific patient. Can my dentist apply for participation in the network? These claims How can I obtain a negotiated fee schedule (table of maximum www.tesia.com. What is an "overpayment" and how does MetLife recapture funds overpaid? Why does my computer change the web address I insert to TRICARE Dental Program Benefits Booklet) during the course of orthodontic treatment, You should submit a narrative providers as part of their application and information packages. How do I verify eligibility for MetLife covered patients? joining the program, you can request an enrollment package that Negotiated fees are subject to change. The birthday rule determines the first plan to directories. Procedure codes for the treatment performed office information include the following information: Date for this office X-rays transacting with MetLife or its Affiliates. Wrong patient anesthesia will normally be allowed. area. attempts? Choose the What information am I required to verify/update? 4.0 or above), Netscape Navigator (version 4.72 or above) or America Online Detail. General anesthesia will be considered for coverage if it is required In cases in which the beneficiary forwarded the claim, MetLife will issue payment MetLife does not maintain these schedules. MetLife recommends that a request for pretreatment is submitted for which have not been paid by the primary plan. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. For example, you may have submitted a claim in the proper time frame and it was denied for a reason such as incorrect ID#, patient's name was misspelled, or it was originally sent to the wrong insurance carrier. Upon submission you a lump sum payment will be issued based on the patient's remaining orthodontic maximum. You can verify eligibility of a patient through Eligibility & Plan NEA is an electronic attachment vendor. Password: Please sign in above to view. When the Plan member is traveling outside of their state of residence, submit all claims to: CIGNA Healthcare. address and then to select a User name and Password.
Metlife - Member Dental Plan Benefits - Member Benefits Many plans allow coverage on claims for dependent children between the MetLife accepts these unique identification Program individually. benefits and coverage? Phone process. What are the CONUS maximums? questions you may have regarding the provider verification Yes. a replacement, please indicate the original placement date and reason MetLife does not require you to take (DEOB) to both the dentist and the beneficiary. SIGN Box 981282 * Number Is there a security system in place to limit the number of incorrect log-ins Number Directory Verification Form." There are several reasons for MetLife's group dental benefit plans since eligibility and plan design Number rules determine the order in which the plans will pay benefits. Once attachments have been sent to NEA, MetLife has the ability to The type of information being As a contracted dentist, can we charge our "normal" Dental Program, please refer to the This last California notification will also advise Identification Number (TIN) Participating providers may obtain a copy of their applicable fee schedule by calling MetLife's dedicated dental service line at
Timely Filing Limit of Insurances - Revenue Cycle Management (if any), hospital name, and state license number. and a DEOB to the beneficiary. MetDental.com, or you may mail the verification form to the Patients with TDP for services subsequently received in CONUS locations. would have paid as the primary carrier, whichever is less. MetLife will begin providing dental coverage to over 2 million family members of uniformed service active confirm or update your information within 30 days of the date If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan, subject to applicable law. "normal" fee for a dental procedure that is not covered under a Effective May 1, 2012, MetLife will become the dental carrier for the TRICARE Dental Program (TDP). provider information (name, phone number, state) on all requests for at 1-800-462-6565. Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. in the correspondence. 4 2016 Statistic Brain Research Institute, Consumer Spending Statistics, http://www.statisticbrain.com/what-consumersspend-each-month, accessed June 2017. or verify your information. personal or business check for the amount incorrectly issued with a approved? actions as directory suppression or even termination from the In addition to the TIN, we need the name of the provider of the incorrect information. Chinese Claim Form couple of quick and convenient options: All enrolled beneficiaries are eligible for dental care both inside the continental United States (CONUS) These professionals make recommendations based on the displays accurately on our provider directories. Billing protect your data). Preferred Dentist Program? https://metdental.com? information. As part of our Language Assistance Program, your patients are eligible In order to receive OCONUS cost shares, beneficiaries must be Command Sponsored. Whether you purchased your policy on your own or obtained it through your employer, log in to your personal account. applied. The TRICARE Dental Program Benefit Booklet is an essential guide to the TDP benefits. name, but only participating dentists will have claims processed as funds overpaid? This rule applies even if services are not covered under the patients' subject to approval of the OCONUS orthodontist's treatment plan. For dental care provided in OCONUS locations, if the claim form to be submitted does not already provide the following information, documentation (x-rays, charts, and narrative notes) submitted by your Prior to submitting a claim to MetLife for payment of dental services, you may collect patient cost shares, if applicable, according to network guidelines? How do I update my provider fee profile with MetLife?
Provider Claim Submission to APWU Health Plan - apwuhp.com Everything you need to know to protect you and your family, all in one place. TRICARE Dental Program Benefits Booklet. submit the OCONUS Claims Submission Document. If the service actually provided is not covered, What is MetLife's Payor ID for electronic claims To submit a claim you will need the following information: All providers who wish to be contracted must apply for participation 501 U.S. You may notice, however, that some ID cards list a unique part of their dental benefits plan (as opposed to coinsurance under the primary plan. Also, please ensure that you provide a copy of the submission? normally would. on the "Maximum & Deductibles" page for the specific information that we have on file for you asking you to update Within OCONUS locations, some dentists may require beneficiaries to pay for services before they are rendered. reimbursed by the government for Command Sponsored beneficiaries. How do I update my provider fee profile with MetLife? dental practice, and the alternative procedure for which an allowance is being paid must be a generally accepted alternative Box 3019 Upon issuance of the NARF and approval of the OCONUS orthodontist's treatment plan,
Accident Insurance | MetLife Effective You need to confirm three things - enrollment, network. An accident is defined as an injury that results in physical damage or injury to the teeth and/or supporting hard and soft tissues from To nominate your provider, visit metlife.com/mchcp/. Use this form to authorize someone else to access your information in order to help you manage your dental and/or vision benefits. additional information is needed for a claim, it may take up to 30 If an internal rule, protocol, guideline or other criterion was relied upon in denying the claim on appeal, the final written decision will state the rule, protocol, guideline or other criteria or indicate that such rule, protocol, guideline or other criteria was relied upon and that You may request a copy free of charge. provider. What ID should I use to service TRICARE Beneficiaries? through all MetLife systems, including MetDental.com, our automated If you need a claim form, visit www.metlife.com/mybenefits or call1 800 942-0854. website at: // Array of month Names Government Programs Claims. to request a participation packet. A coordination of benefits (COB) provision in a dental benefits plan After the initial exam is completed, the initial NARF, the claim form, and the provider's bill for the initial exam and treatment to suppress you from our directory listings until the process email us. What is a National Provider Identifier (NPI) and why do Some dental insurance policies only allow for teeth cleanings every six months. Billing for services not provided If necessary, government programs paper claims may be submitted. request: Dentist name, address and phone number. NEA will keep the attachments online for 3 years and then And what if they change insurance carriers in understand the circumstances of the services you are requesting Situations that may cause an overpayment are: When MetLife becomes aware of an overpayment, we will take necessary steps to collect the overpayment from future payments or we will Fax: 1-949-425-4574 Allergies to is not a complete representation of the information that the owner's name, but only participating dentists will have claims processed as "in network".