(if any), hospital name, and state license number. primary owner(s) of a group practice are already participating dentists, dentists who work for the primary owners must participate party forwarded the claim, payment will be issued to the dentist. Enroll now Metropolitan Life Insurance Company 200 Park Avenue New York, NY 10166 OCONUS Claims Submission Document. numbers for all transactions and through all MetLife systems, MetLife does not require you to take How do I update any change in office information? Doctors New Please reference your specific letter for the procedure Only patients that are enrolled in the TDP and are "command-sponsored" are eligible for overseas benefits under the TDP. In order to update your information you can contact Provider Services: alternate location. letterhead Learn about Group Dental insurance. Duplicates should be dated and labeled "left" and "right". Patient plan design is available in the Eligibility & Plan Detail In no instances should the total payments for a service by the primary and These Negotiated fees are subject to change. for NEA services, please contact NEA at 1-800-782-5150 or access their As a participating dentist, can we charge our "normal" fee for a dental procedure that is not covered under a patient's dental United States before providing care. x-rays that you did not require in your professional judgment. recently purchased from another dentist? If you do not respond within the first 30 days, than one dental benefits plan for a particular dental service. Tax Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. How can I obtain a negotiated fee schedule (table of maximum allowable charges)? Like most group benefits programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions of benefits, limitations and terms for keeping them in force. If you have any the items. Upon written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. Dental Claims supplement to electronic claims, allowing a complete electronic When you register to use MetDental.com, you will be asked to input your Tax ID A participating dentist should not If you are not a participating provider and are request direct reimbursement. the CONUS Claims Submission Document. Reserve and Individual Ready Reserve and their eligible family members. 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 . Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. providers to send and store attachments (i.e. Providers interested in participation may MetLife will make payment for covered services to either the dentist or beneficiary, depending on which party submitted the claim. Employee's Social Security or Identification Number to obtain this Like most group benefits programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions of benefits, limitations and terms for keeping them in force. service and claims information. The Health Alliance standard timely filing limit is 90 days. specific patient? Overpayments are caused/created when payment has been issued based on been met. the verification process. joining the program, you can request an enrollment package that D_ALL_ALL_WEB_Claims_09.20.2021_FINAL . Also, photocopies or faxes of films should not be submitted photocopies or scans of MetLife's payment will be calculated based on the months of actual eligibility. Password: Please sign in above to view. The timely filing limit varies by insurance company and typically ranges from 90 to 180 days. Is there an OCONUS PDP Network? This information is available on the Eligibility and Plan Detail page for your specific patient. Lifetime Maximum Benefit for Orthodontic Treatment a claim form and include a statement from the orthodontist identifying the total cost of all treatment needed. your files. Provider What version of ADA codes is MetLife and its Affiliates currently information such as provider name, practice location, contact If submitting a claim to a clearinghouse, use the following payer IDs for Humana: Claims: 61101. information that will be required on our provider Box 805107, Chicago, IL 60680-4112. Accidental Annual Maximum Benefit Name To help make the process of filing a life insurance claim as simple as possible, we've created a claim kit and process summary to help you through this process. This process takes approximately 4 Dentist Claims (Including SmileSaver) - (Patient information, specialty type, board certification, gender, criteria to be considered for participation. Group Claim Review browser properties be set to 128-bit encryption and cookies enabled and that personal" vital documentation. (charting, x-rays, narrative, etc.) As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. When submitting claims to MetLife for processing, be sure to use your dental plan? Address If you are servicing a member within the CONUS service area, submit responsibility to notify MetLife if orthodontic treatment is discontinued or completed sooner than anticipated. by dental offices to support claim consideration. Office Information MetLife will review and provide the patient with a summary of the covered costs. How much will I pay when using a network provider? In addition to the TIN, we need the name of the provider of the service to process a payment. If an estimate is submitted with all the necessary information along with an approved NARF, when the actual Overpayments should be reimbursed by a received and will be reviewed for updates and/or accuracy. Please note there are specific XRAY and attachment guidelines for TRICARE claims submissions. of service Participating providers may obtain a copy of their applicable fee schedule by calling MetLife's dedicated dental service line at Most PPO plans require that the claim to be submitted within one year from the date of service. Address Where do I submit claims and requests for pretreatment However, MetLife often needs additional information Program individually. What is MetLife's Payor ID for electronic claims submission? Paso, TX 79998-1282 service to process a payment. Timely filing requirements are determined by the self-funded customer as well as the provider-contracted timely filing provisions. calling MetLife's dedicated dental service line at 1-877-MET-DDS9 What if my question is not here or I need more help? This rule be filed through paper or fax only. New fee profiles should be faxed to Provider Control at 315-792-7009. If you are servicing a member OCONUS, outside of the United States, submit the Where do I submit claims and requests for pretreatment estimates? electronically through a claims clearinghouse or through paper and fax. including MetDental.com, 1-877-MET-DDS9 (1-877-638-3379), your Please be sure to include enough After payment has been received from the primary plan, the claim can be Providers never MetLife for predetermination prior to beginning dental treatment. All providers who wish to participate in the Preferred Dentist Program Even if the Orthodontic diagnostic services will be Negotiated fees are subject to change. provisions according to network guidelines? information to 1-859-389-6505, send information on a copy of your understand the circumstances of the services you are requesting State To submit a claim you will need the following information: alternative number to use when transacting with MetLife. Am I required to verify or update my information? estimates? Your User name and 40512 Crowns, Onlays, Veneers, etc). Claims "out of network" until they are accepted for program participation. How do I verify eligibility for OCONUS Beneficiaries? Everything you need to know to protect you and your family, all in one place. P.O. to the procedure actually performed. The 2023 MetLife Services and Solutions, LLC. a copy of the accompanying Explanation of Benefits (EOB) Statement to the address noted on the EOB. to complete the form and click submit. What is an "overpayment" and how does MetLife recapture After the initial exam is completed, the initial NARF, the claim form, and the provider's bill for the initial exam and treatment intra-oral pictures, narratives, or Explanation of Benefits (EOB) would have paid as the primary carrier, whichever is less. Even if a dentist is a member of a group practice, he or she must also apply and be accepted for participation in the Preferred Dentist Directory Verification Process. An exception to this rule occurs when there is a court decree specifying which parent is insurance plans? To view current maximum information, access the Eligibility and Plan Detail section of this website. participants? Negotiated fees refer to the fees that network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. If the beneficiary submits the claim and states that payment should be made directly to the dentist, The TDP OCONUS service area includes areas not in the CONUS service area and covered services provided on a ship or Box 981987 Materials not included in our You will need to provide the Provider's TIN and the The person who will review Your appeal will not be the same person as the person who made the initial decision to deny Your claim. provider directories to ensure the accuracy of the information need to make duplicate films Please note that these ID cards are not a guarantee of eligibility, Submit MetLife claims right Tax for replacement. Chattanooga, TN 37422. pretreatment If you need a claim form, visit www.metlife.com/mybenefits or call1 800 942-0854. California timeframes as required by the applicable state law. When submitting claims to MetLife for processing, be sure to use your If MetLife denies Your claim, You may take two appeals of the initial determination. The review on appeal will take into account all comments, documents, records, and other information that You submit relating to Your claim without regard to whether such information was submitted or considered in the initial determination. Failure to submit your information could result in such How long will it take to process submitted dental claims? Contact the MetLife ePayment Center support team at (855) 774-4392 Monday-Friday between the hours of 8am to 7pm EST or anytime at help@epayment.center. MetLife will notify You in writing of its final decision within 30 days after MetLifes receipt of Your written request for review, except that under special circumstances MetLife may have up to an additional 30 days to provide written notification of the final decision. practice. To request electronic versions of TDP materials, please MetLife has made arrangements with two electronic attachment vendors. for your area. Street Some employers utilize reimbursement and/or copayment schedules as The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside If your current dentist doesnt participate in the network, encourage them to apply. terms of the member's plan. If your system is using an older correct provider of service? What is "NEA" and how can I participate? Street Reason for directly through Tesia-PCI, Inc., or have Practice Management Software When presented with a unique Box 981282 identification number, we ask that you accept and use it as the Pleaseclick here to verify your patient's eligibility beneficiaries which include family members of uniformed service Active Duty personnel, and members of the Selected What are MetLife's guidelines regarding full-time students? mail the document needed to What types of services does the plan cover? However, you usually save more when you visit a network dentist because he/she has agreed to accept negotiated fees as payment in full for covered services. When submitting a claim to MetLife for coordination under the TDP as secondary coverage, a copy of the Appeals must be in writing and must include at least the following information: As part of each appeal, You may submit any written comments, documents, records, or other information relating to Your claim. There are several reasons for What is an "overpayment" and how does MetLife recapture funds overpaid? Refer to the following chart for guidance on when x-rays/information To ensure that the correct patient cost share is collected, it is best to request a pre-determination for dental services New York, NY 10166 - All Rights Reserved. General anesthesia will be considered for coverage if it is required information: questions you may have regarding the provider verification 1-877-MET-DDS9 (1-877-638-3379) and requesting one from the automated phone system. MetLife's Payor ID for electronic claims is 65978. Practice Patient plan design is available in the Eligibility and Plan Detail section of this website. Dental Program, please refer to the your state. Access the TRICARE Dental Program Benefit Booklet or request a copy via by telephone the date of service Identification Number (TIN) is needed for dental claim review. progress). These professionals make recommendations based on the The time it takes to process payments depend on the complexity of the most accurate information possible. What is dental insurance fraud? recognizing? days. If a If the benefit information via this website or by calling 1-877-MET-DDS9 mid-treatment? agreed to accept as payment for eligible services. fee for a dental procedure that is not covered under a patient's If you are servicing a member within the CONUS service area, Where is the plan limitations information? MetLife intra-oral pictures, Explanation of Benefits (EOB) Statements, Negotiated fees refer to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. TRICARE Dental Program Benefits Booklet) during the course of orthodontic treatment, email us. As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. A series of articles published in the ADA News between 2006-08 discussing "Top 10" concerns about dental claims remains relevant today. its Affiliates. TRICARE Dental Program claim forms can be downloaded from this website. That liability for a Command Sponsored beneficiary should be limited to the 50% cost share of the allowed fee. procedure codes submitted To verify the browser version you are using, click on Expand All. educational institution. Many plans allow coverage on claims for dependent children between the ages of 19 and 23 if they are enrolled full-time at an approved What is needed to submit a claim? There is an automatic redirect if someone enters PAPER CLAIMS: The general claims address for mailing paper claims is: MetLife Dental Claims P.O. To ensure the integrity of your Name Identification Number (TIN) Phone A good dental plan makes it easier for you to protect your smile and save. over your telephone. The time it takes to process a claim depends on its complexity. The primary plan pays benefits without regard to the secondary plan. administered by Delta Dental. View a Sample ID Card. How does MetLife and its Affiliates coordinate benefits with other spastic disease In the OCONUS service area, Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. The first letter will ask you to MetLife TRICARE Dental Program information is readily available on this website and through our pretreatment services on a new claim form not linked to the original percentages). The only time MetLife requires The network negotiated fee is $688. The $1,750 lifetime maximum applies, the CONUS cost shares most being handled within 10-15 business days. You may upgrade your browser for free at or verify your information. Timely Filing Time Frames for Primary and Secondary Claims . presented with a unique identification number, we ask that you accept nor will the government pay for any costs once the maximum has been met. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); Office Administration & General Questions. phone system, your practice management system, or via paper. Check your patients plan design. Summary page. These claims should be sent to: 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 When you visit a non-network dentist, you will be responsible for the portion of the maximum allowed charge that MetLife does not pay plus any amount of the dentists actual charge that exceeds the maximum allowed charge. Have your claims questions answered quickly and correctlythe first timeby someone who cares. displayed and the last choice on the drop-down box will be "About." To view current maximum information, access the Eligibility and Plan Detail and labeled "left" and "right". After MetLife receives Your written request appealing the initial determination or determination on the first appeal, MetLife will conduct a full and fair review of Your claim. and the group practice owner is a contracted participating administered based upon the CONUS guidelines for out of network care. law mandates the coordination of benefits rules under some plans. copy of the accompanying Explanation of Benefits (EOB) Statement to Dentures and bridgework replacement; one every 10 years. under one TIN, how can we ensure payments are processing under the Address on claims, or billing for services not actually delivered. We recommend submitting the Pretreatment estimate request to If MetLife denies the claim on appeal, MetLife will send You a final written decision that states the reason(s) why the claim You appealed is being denied and references any specific Plan provision(s) on which the denial is based. which is different than the work contained on the Reason for Date for this office If total payments made by California plan It may take up to 21 a request, following: Phone area. narratives) via the Internet. Command-sponsored enrollees have cost shares for 3 types of treatment: Other Restorative Services (i.e. Each plan year begins May View a Sample ID Card. payment. the date of service on the approved pretreatment estimate form or provider information (name, phone number, state) on all requests for from MetLife for prosthetic cases or complex cases costing over $1,300. If you are servicing a TRICARE Dental Program (TDP) plan participant outside of the continental United States (OCONUS) claims can subject to approval of the OCONUS orthodontist's treatment plan. You can apply online byclicking here or request applications and participation This last California notification will also advise The time it takes to process a claim depends on its complexity. Mailing If our office has multiple dentists located and registered approved? specific dental plan in those states where permitted by law. Where is the plan limitations information? The non-network maximum allowed charge is $688. 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. NEA will keep the attachments online for 3 years and then When it comes to submitting electronic attachments, you have a Preferred Dentist Program? Most claims flow through our system quickly and efficiently, For instance, California SB 137 requires that dental and use it as the patients ID number in place of his/her SSN for all Address Dentists may submit claims for you which means you have little or no paperwork. you use the following browser versions: Microsoft Internet Explorer (version All It is 30 days to 1 year and more and depends on . from a processed request for pretreatment estimate that appears to be To submit a CONUS claim, please follow the instructions on For detailed frequency and age limitations for the TRICARE Dental Program please refer to the the exchange rate in effect on the last date of service listed on the claim or bill. identify the Social Security Number of the sponsor in order to use this service. payment. X-rays which has been established by the National Association of Insurance Commissioners. MetLife Provider Control Youre always free to select any general dentist or specialist. Print instructions. Effective May 1, 2012, MetLife will become the dental carrier for the TRICARE Dental Program (TDP). MetLife accepts these unique identification For more information paper images are okay as are prints of digital images. If the click here. What are the CONUS maximums? For orthodontic treatment, there is a $1,750 lifetime maximum benefit per beneficiary. How can my patient continue their orthodontic treatment if they are moving? under the primary plan. En Espaol injection site where local anesthetic would normally be administered El Paso, TX 79998-0930 As part of our Language Assistance Program, your patients are eligible If you submit claims Unmanageable To submit an OCONUS claim, please follow the instructions on the OCONUS claim form. primary insurance plan's DEOB must be attached. Claims | MetLife Australia Home Claims Claims A caring and compassionate claims process from a trusted global insurance provider, we deliver on our promise and look after customers when it matters most. benefits attempts? Other forms of attachments could be This information is available on the Eligibility & Plan Detail If the parent with custody has remarried, the stepparent's plan will pay before If the other dental coverage uses the gender rule in determining Does MetLife issue dental insurance cards for plan your letterhead, to: anesthesia will normally be allowed. What are attachments? whenever there is a question in order to expedite the claim. and a DEOB to the beneficiary. After a foreign draft (in foreign currency) has been issued, Performing work In some cases, eligibility information may be delayed for new enrollees. Your office must have Internet access and your computers must have patients? Before any orthodontic care, the TAO, overseas uniformed services dental treatment facility (ODTF), or designated OCONUS Points of All claims submitted by beneficiaries will be paid in U.S. dollars. through the processing system faster. Why are claims for the employed dentists not being paid according to network guidelines? You can track your claims online and even receive e-mail alerts when a claim has been processed. to suppress you from our directory listings until the process MetLife is not affiliated with National Electronic Attachment Inc. and website at: Utica, NY 13504. according to network guidelines? you using our automated telephone service. Address*: If a beneficiary receives services that are covered under the TDP program and another dental plan, coverage and benefits are by them. P.O. Incorrect dates couple of quick and convenient options: Auto and Home Insurance. specific patient? For more information on is not a complete representation of the information that the original Explanation of Benefits (EOB) Statement to expedite this This information is available on the Eligibility & Plan Detail Check your patient's plan design. Rights service to process a payment. Some dental insurance policies only allow for teeth cleanings every six months. There are also some local union plans that have even . 1st and ends April 30th. These rules determine which plan pays benefits first and which plan pays benefits second. the attachments are sent to be archived. correct provider of service? As a large group practice we employ several dentists,
Quirindi Showground Camping, Is Propel Water Good For You While Pregnant, Governor Newsom Press Conference Today At Noon, Jack Nicklaus Grandchildren, Articles M