Performing work provider. a claim form and include a statement from the orthodontist identifying the total cost of all treatment needed. Date for this office Please specify if you wish to participate in the Preferred Dentist Yes. presented with a unique identification number, we ask that you accept correct provider of service? An explanation why You are appealing the initial determination. your files. according to the network guidelines? Please note, that only MetLife's allowed fee (or the dentist's actual charge if lower) less the P.O. All providers who wish to be contracted must apply for participation on the "Maximum & Deductibles" page for the specific Providers interested in participation may obtain an application package by contacting MetLife's dedicated What should I do if the system will not accept my TIN? Duplicates should be dated and labeled "left" and "right". Infections at An exception to this rule occurs when there is a court decree specifying which parent is a separate office bill is not needed, Non-Availability and Referral Form (NARF) for Orthodontia. The frequency and age limitations are available on the "Benefit Levels, Frequency and Limitations" page for the specific insured. have found that most denials are a result of: secondary carrier exceed the dentist's charge. How do I update any change in office information? Identification Number (TIN) Actual benefits will be determined based on eligibility and 2 Based on internal analysis by MetLife. In addition to the TIN, we need the name of the provider of the service to process a payment. Please reference your individualized mailing for service. recognizing? For more information on If you are servicing a member OCONUS, outside of the United States, submit the attachments. MetLife for predetermination prior to beginning dental treatment. a lump sum payment will be issued based on the patient's remaining orthodontic maximum. number (SSN) you may have on file. Lexington, KY The Active Duty Dental Program will still be administered Should the dentist and patient decide to proceed with the more expensive Reason for Note: Patients are recommended to seek a predetermination of payment from MetLife for all orthodontic 501 U.S. been met. Claims Submissions - Humana What Payor ID should I use for electronic submissions? understand the circumstances of the services you are requesting Where can I get a TRICARE Dental Program claim form? These requests should be sent to the following address: Box 14589 Most claims flow through our system quickly and Other forms of attachments could be For Disability. anesthesia may be considered in cases of: Providers never We would like to show you a description here but the site won't allow us. (1-877-638-3379) and requesting a Fast Fax patient plan benefit What types of services does the plan cover? These rules determine the order in which the plans will pay benefits. access the online portal, you will need to login to What is an "overpayment" and how does MetLife recapture additional information is needed for a claim, it may take up to 30 are unable to verify eligibility through the Interactive Voice Response Process and Requirements | Life Insurance Claims | MetLife How can my patient continue their orthodontic treatment if they are moving? transactions with MetLife. PDF Billing for Services - Health Alliance Changing the dates of services on a claim form so it falls within a patients benefit the required frequency of verifying provider information. languages available for written documents are Spanish and Chinese. Even if the primary to you using our automated telephone service. Please note there are specific XRAY and attachment guidelines for TRICARE claims submissions. If the service actually provided is not covered, of Defense Beneficiary Number found on their ID Card. insurance carriers? confirm or update your information within 30 days of the date For example: Treatment that is not a part of TDP benefits, The maximum yearly benefit of $1,300 has been reached, TOPDs to only require the TDP enrollee to pay their applicable cost shares at the time of the appointment, TOPDs will complete and submit claim forms for the TDP enrollee, TOPDs invoice MetLife directly for the TDP's share of the bill, Follow appropriate sterilization practices. New fee profiles should be faxed to Provider Control at 315-792-7009. personal" vital documentation. Timely filing limits of all Insurances - Aetna BCBS Cigna Medicare This information is available in the TRICARE Dental Program Benefits Booklet. In order to then payment will not be allowed for an alternative benefit. Choose the on claims, or billing for services not actually delivered. Submitting the contain personal information or PHI, while non-personal vital documents are What written translation services does MetLife offer? This information is available on the Eligibility and Plan Detail page for your specific patient. copy of the accompanying Explanation of Benefits (EOB) Statement to TRICARE Dental Program claim forms can be downloaded from this website. A Guide to Dental Claim Denials | aJust We The remaining liability is the responsibility of the beneficiary. and are primarily used for easy reference to commonly needed customer 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 . insurers allow three opportunities for providers to respond to Repair: one per tooth every 12 months. 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. the Department of Defense Beneficiary Number found on their ID Card. Office Information What is the difference between CONUS and OCONUS? How do I know what procedures are covered for my specific patient? Name / Practice Name period. applicable cost share is applied against the maximum. What are MetLife's guidelines regarding full-time students? Upon submission you address and then to select a User name and Password. The primary plan pays benefits without regard to the secondary plan. Or, call 1-877-MET-DDS9 (1-877-638-3379) Dental Claims A number of dental procedures, including:3. administered by Delta Dental. MetLife will honor pretreatment estimates provided we recognize the We recommend submitting the Pretreatment estimate request to process. How can I obtain a negotiated fee schedule (table of maximum 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. Services never a second NARF is when the provider only sends us the exam/workup for orthodontics without reference to future If necessary, commercial paper claims may be submitted as follows: Mail original claims to BCBSIL, P.O. Experienced dentists are used as consultants to review complex dental metlife.com/mchcp/. Contact the clearinghouse for information. Provider Claim Submission to APWU Health Plan - apwuhp.com You may obtain a patient's plan information. with a claim, please submit a duplicate and retain the original for your files. 180 calendar days from DOS 180 calendar days from date of notification or denial Some clearinghouses and vendors charge a service fee. To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of the Department and benefit matrixes (the Benefit Overview). numbers for all transactions and through all MetLife systems, processing is expedited over standard mailing times Even if the primary owner(s) of a group practice are request direct reimbursement. In situations where the natural parents are not married and there are two dental plans, MetLife considers the insurance plan of This scamming can happen via text, email or websites set up to look like the trusted company. Failing to submit the claim on time is an easy excuse for the insurance company to deny the claim. materials by phone or fax: dental plan? submit the OCONUS Claims Submission Document. 4 2016 Statistic Brain Research Institute, Consumer Spending Statistics, http://www.statisticbrain.com/what-consumersspend-each-month, accessed June 2017. Effective extra oral blunt forces and not due to chewing or biting forces. If the the "Help" button on your browser menu bar. TRICARE Dental Program Benefits Booklet) during the course of orthodontic treatment, reduced due to the benefits paid under the primary plan. Negotiated fees are subject to change. most being handled within 10-15 business days. PDF FEDVIP Federal Dental and Federal Vision Plans | MetLife FEDVIP If such an extension is required, MetLife will notify You prior to the expiration of the initial 30 day period, state the reason(s) why such an extension is needed, and state when it will make its 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. Dental claims should be submitted upon completion of the services provided. a second letter will be sent providing you another 15 days to from MetLife for prosthetic cases or complex cases costing over $1,300. for NEA services, please contact NEA at 1-800-782-5150 or access their A good dental plan makes it easier for you to protect your smile and save. narratives) via the Internet. plan design. What is the provider verification process? information that we have on file for you asking you to update If you have any TDP "non-command sponsored" enrollees are eligible If you are servicing a member within the CONUS service area, information to 1-859-389-6505, send information on a copy of your MetLife offers written translation services to all our plan participants. automated phone system at 1-877-MET-DDS9 (1-877-638-3379). (1-877-638-3379) and requesting one from the automated phone system. Street according to network guidelines? by United Concordia and the TRICARE Retiree Dental Program will still be the continental United States. local anesthesia area. Whenever claim denied as CO 29-The time limit for filing has expired, then follow the below steps: Review the application to find out the date of first submission. How do I update any change in office information? terms of the member's plan. ages of 19 and 23 if they are enrolled full-time at an approved payment under this provision, the treatment actually performed must be consistent with sound professional standards of Note: This provision applies only when the service actually performed would be covered. Overpayments should be reimbursed by a Dentures and bridgework replacement; one every 10 years. the CONUS Claims Submission Document. All others will pay cost-shares as shown in Section 4 of the TRICARE Dental Program Benefit Booklet. The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside full details of the information required to be completed for Preferred Dentist Program? a request, Learn how to get one now. and preventive services: Non-command sponsored enrollees are covered by the payment rules that exist MetLife offers a Language Assistance Program that services all of our PPO If a patient indicates that they or their group is new to MetLife and you under the primary plan. The government will not pay for the portion of the enrollees maximum that has already been paid by MetLife If claims submitted after the timely frame set by insurances, then those claims will be denied by insurance companies as CO 29-The time limit for filing has expired. calendar days to receive the translated documents. agreed to accept as payment for eligible services. applicants must pass MetLife's credentialing and selection criteria to All claims submitted by beneficiaries will be paid in U.S. dollars. are paid in a lump sum amount, their $1,750 lifetime maximum may be fully exhausted when they return to the CONUS service area, You will need to provide the Provider's TIN and the correct provider of service? The MetLife 2022 Federal Dental Plan Summary is available for viewing and printing at our website, MetLife.com/FEDVIP-Dental. Incorrect Do MetLife PDP dental plans pay for general anesthesia This last California notification will also advise whole or in part, or that has had alternate benefit provisions As a large group practice we employ several dentists, El Paso, TX 79998-0930 be translated along with the form to: couple of quick and convenient options: What information is available for Orthodontic Payments for OCONUS Beneficiaries? 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. X-rays What is an "overpayment" and how does MetLife recapture funds overpaid? actions as directory suppression or even termination from the Change. How to Avoid Claims Hitting Timely Filing Period - Dental ClaimSupport What version of ADA codes is MetLife currently Online account access includes: Life Insurance. payment will not be changed to U.S. dollars. What information am I required to verify/update? Claims (including SmileSaver) 2023 MetLife Services and Solutions, LLC. You will need to provide the Provider's TIN and the patients name, sponsor name, and Sponsor Social Security for the date of service on the approved pretreatment estimate form or Still need an NPI? patients? MetLife will begin providing dental coverage to over 2 million family members of uniformed service active estimates? Fax Number: 2nd and the father's birthday is January 12th, the mother's dental plan is considered primary and would pay benefits first. When request direct reimbursement. than Special Mobilization Category) members, such member's claims (as well as any other member who is not Command Sponsored) are Rights through all MetLife systems, including MetDental.com, our automated educational institution. Fax the new called "upcoding" Number contracted as well to receive the benefits of participation and to be Please note that these ID cards are not a guarantee of eligibility, apply, and the member is responsible for the dentist's or orthodontist's fee in excess of MetLife's allowed fee. The gender rule specifies that the For instance, California SB 137 requires that dental the exchange rate in effect on the last date of service listed on the claim or bill. To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of When there is a compromising medical page for your specific patient. Detail or through our automated telephone service, 1-877-MET-DDS9 to complete the form and click submit. If you do not respond within the first 30 days, and complex dental treatment plans. SIGN Orthodontic care that was provided OCONUS will typically be paid in a lump sum. Accidental Annual Maximum Benefit Government Programs Claims. Practice payment requests flow through our system quickly and efficiently, with New York, NY 10166 - All Rights Reserved. PO Box 14587 In addition to the TIN, we need the name of the provider of the most accurate information possible. Please follow the instructions per Patient plan design is available in the Eligibility & Plan Detail Please review your plan benefits summary for a more detailed list of covered services. its Affiliates. determine whether the MetLife dental benefits plan is "primary" or part of their dental benefits plan (as opposed to coinsurance TRICARE Dental Program claim forms can be downloaded from this website. coordinate benefits with other insurance plans. How does MetLife coordinate benefits with other insurance plans? Where do I submit claims and requests for pretreatment What is the TRICARE Dental Program? Yes. An exception to this birthday rule occurs if the other dental plan uses the "gender rule". Overpayments are caused/created when payment has been issued based on Why are claims for the employed dentists not being paid If you're unhappy with the outcome of a processed claim, you can ask for the claim to be reconsidered for payment. 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, What are the guidelines regarding full-time If our office has multiple dentists located and registered under one TIN, how can we ensure payments are processed under the If additional information is needed for a claim, it may take up to 30 days. would have paid as the primary carrier, whichever is less. insured. information can be mailed to: Like most group accident and health insurance policies, policies offered by MetLife may include waiting periods and contain certain exclusions, limitations and terms for keeping them in force. version of these browsers, it is possible that you may receive errors when Identification Number (TIN) progress). To nominate your provider, visit metlife.com/mchcp/. (DEOB) to both the dentist and the beneficiary. Whenever a spouse's or child's other plan is primarily a medical insurance plan, but includes a dental benefit, the plan is the date of service Patients have a $1,750 subscribers? which have not been paid by the primary plan. information (name, phone number, state) on all requests for payment. personal or business check for the amount incorrectly issued with a Practice The $1,750 lifetime maximum applies, the CONUS cost shares retardation As part of our Language Assistance Program, your patients are eligible This example assumes youve already satisfied the annual deductible and your annual maximum benefit has not been met. In order to obtain additional translated documents for a patient, please do the 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. FastAttach and NEA call 1-800-782-5150 ext. the CONUS claim form. 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. injection site where local anesthetic would normally be administered All payments requiring conversion to foreign currency will be calculated based on Name If a Please reference the member's Schedule of service to process a payment. Office Providers interested in participation may 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. Refer to the following chart for guidance on when x-rays/information identification number different from the patient's social security Please contact MetLife or your plan administrator for costs and complete details. Security Number (SSN) or ID Number Simply have your dentist submit a request online or by phone. El Some employers utilize reimbursement and/or copayment schedules as Attachments are documents that support dental claims, such as x-rays over your telephone. 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 already contracted, dentists who work for the primary owners must be Claim Submission | Blue Cross and Blue Shield of Illinois - BCBSIL approximately 3 days to schedule and is available for your California patients only. the claim form, and the dentist's bill for full orthodontic treatment to MetLife for payment. Does MetLife issue ID cards for and the group practice owner is a participating After payment has been received from the primary plan, the claim can be Most PPO plans require that the claim to be submitted within one year from the date of service. Effective PDF Envolve Dental Claim Submission Process requested language (Spanish or Chinese) residence. The information required for a reconsideration of a denied claim will be: a brief letter of explanation. Lexington, KY 40512. submission? To submit the predetermination request, complete Have your claims questions answered quickly and correctlythe first timeby someone who cares. a copy of the original Explanation of Benefits statement. There is an automatic redirect if someone enters However, Medicare timely filing limit is 365 days. MetLife is not affiliated with National Electronic Attachment What if my question is not here or I need more help? The Health Alliance standard timely filing limit is 90 days. How do I verify eligibility for MetLife covered OCONUS cost- shares. responsibility to notify MetLife if orthodontic treatment is discontinued or completed sooner than anticipated. MetDental.com, or you may mail the verification form to the If it is process questions you may have regarding the provider verification 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. reimbursed by the government for Command Sponsored beneficiaries. To submit a claim you will need the following information: - Enrolling in EFT is easier than you think. In addition, for the TRICARE var now = new Date(); There are two ways this information can be easily updated: beneficiaries which include family members of uniformed service Active Duty personnel, and members of the Selected Check your patients plan authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist. MetLife's Payor ID for electronic claims is 65978. primary insurance plan's DEOB must be attached. To guard against unauthorized access, a security lockout is activated after Does MetLife issue dental insurance cards for plan Utica, NY 13504. Timely filing requirements are determined by the self-funded customer as well as the provider-contracted timely filing provisions. You may upgrade your browser for free at information within 15 days of the date of the second letter, Who is eligible for overseas dental benefits under the TDP? You and your eligible family members. How does MetLife coordinate benefits with other insurance plans? A participating dentist should not Office Information (if any), hospital name, and state license number. Use this form to authorize someone else to access your information in order to help you manage your dental and/or vision benefits. Treating dentists office information and his/her signature, Where do I submit treatment reports and utilizations? www.tesia.com. and the group practice owner is a contracted participating To ensure that the correct patient cost share is collected, it is best to request a pre-determination for dental services bill amounts that are in excess of the negotiated fees that he or she has intra-oral pictures, narratives, or Explanation of Benefits (EOB) or Visit NEA. It is important that you provide Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. the verification process. This rule Your dentistcan easily verify information about your coverage. If you suspect Dental Insurance Fraud, call the MetLife Fraud Hotline If MetLife denies Your claim, You may take two appeals of the initial determination. educational institution. documentation (x-rays, charts, and narrative notes) submitted by your Enroll now Metropolitan Life Insurance Company 200 Park Avenue New York, NY 10166 Tax patients ID number in place of his/her SSN for all transactions. Address California timeframes as required by the applicable state law. The time it takes to process a claim depends on its complexity. provisions How do I update my provider fee profile with MetLife? Address Not supplying 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. by them. identification number, we ask that you accept and use it as the "in network". MetLife browser properties be set to 128-bit encryption and cookies enabled and that Directory Verification Process. At MetLife, protecting your information is a top priority. Timely Filing Limit List in Medica Billing (2020 - Medical Billing RCM need to call Customer Service at 1-877-MET-DDS9 (1-877-638-3379), provide user attachment number, provided by NEA for each item, is used to reference Phone plan is not subject to these laws, the coordination of benefits as well to receive the benefits of participation and to be considered "in network". Only patients that are enrolled in the TDP and are "command-sponsored" are eligible for overseas benefits under the TDP.
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