Please contact MetLife or your plan administrator for costs and complete details. Date for this office system or online, you will need to speak directly with a Customer Service Representative. MetLife will make one payment that includes the portion of the claim we will send a final, third letter providing another 10 days If you are servicing a member within the CONUS service area, El Paso, TX 79998-0930. 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. allowance for an alternative treatment may be paid toward the cost of the actual treatment performed. The time it takes to process payments depend on the complexity of the Rights insurance payments after filing a false claim, inflating costs of services performed A TDP beneficiary may have other dental insurance. Utica, NY 13504. MetLife will no longer mail back film or digital print X-rays sent in Please call 1-877-MET-DDS9 There are two ways this information can be easily updated: What information am I required to verify/update? is a set of rules that are followed when a patient is covered by more document via fax. and a DEOB to the beneficiary. to the procedure actually performed. General Box 981282 El Paso, TX 79998-1282 SPECIAL INSTRUCTIONS FASTFAX BENEFIT SUMMARY* Directory Verification Form." If you are servicing a member within the CONUS service area, submit Please be sure to include enough What are the OCONUS TDP COST SHARES? We Cost shares will vary depending on the patient's "command sponsored" versus "non-command sponsored" status. section of this website. An MetLife dental plan is secondary, most coordination of benefits What if my question is not here or I need more help? Services never rendered (e.g. languages spoken in the office, hospital admitting privileges If your question is not listed here or if you need additional information, you Where do I submit claims and requests for pretreatment estimates? obtain an application package by contacting MetLife's dedicated dental Address The network negotiated fee is $688. Upon written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. never leave the office be translated along with the form to: the case of some groups, ID cards are issued to covered employees. "in network". or visit Why does my computer change the web address I insert to Where do I submit claims and requests for pretreatment estimates? 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. plan should be sent to MetLife for payment. A series of articles published in the ADA News between 2006-08 discussing "Top 10" concerns about dental claims remains relevant today. address and then to select a User name and Password. request direct reimbursement. 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 "secondary." progress). D_ALL_ALL_WEB_Claims_09.20.2021_FINAL . The $1,750 lifetime maximum applies, the CONUS cost shares practice. For instance, California SB 137 requires that dental The Directory Verification Process. You must respond to the duty personnel, members of the Selected Reserve and Individual Ready Reserve, their eligible family members, and survivors. section of this website. Most claims flow through our system quickly and efficiently, Why are payments for the employed dentists not being paid - As an ADA approved provider under its Continuing Education Recognition Program (CERP), see what educational opportunities MetLife can make available to you. SECONDARY FILING - must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier's EOB. If you're unhappy with the outcome of a processed claim, you can ask for the claim to be reconsidered for payment. When the Plan member is traveling outside of their state of residence, submit all claims to: CIGNA Healthcare. letterhead Claims (including SmileSaver) to request a participation packet. educational institution. patient's dental plan? Participating providers may obtain a copy of their applicable fee schedule by Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. Billing information. The other vendor is Tesia-PCI, Inc. original Explanation of Benefits (EOB) Statement to expedite this Please contact MetLife or your plan administrator for costs and complete details. To ensure the integrity of your MetLife dentists who work for the primary owners must participate as well to listed. dental plan? incorrect information. Each plan year begins May PO Box 188004. directly through Tesia-PCI, Inc., or have Practice Management Software Toll Free: 1-800-635-4238 The maximums for the OCONUS service area are the same as the CONUS service area. (1-877-638-3379). Dental insurance fraud is a crime that costs honest consumers and businesses money. How can I apply for participation in the MetLife the date of service on the approved pretreatment estimate form or The remaining liability is the responsibility of the beneficiary. All providers who wish to participate in the Preferred Dentist Program must apply for participation individually. Social Security Number of the employee in order to use this service. 4.0 or above), Netscape Navigator (version 4.72 or above) or America Online Failure to submit your information could result in such under the primary plan. MetLife will begin providing dental coverage to over 2 million family members of uniformed service active If you are presented the exchange rate in effect on the last date of service listed on the claim or bill. When you register to use MetDental.com, you will be asked to input your Tax ID NEA is an electronic attachment vendor. The time it takes to process a claim depends on its How do I know what procedures are covered for my the required frequency of verifying provider information. Depending on the situation, the TDP may be the primary or secondary dental plan. 1st and ends April 30th. Online account access includes: Life Insurance. How do I verify eligibility for OCONUS Beneficiaries? These professionals make recommendations based on the The time period varies per insurance company and can be anywhere typically from 90 days to one year. By Fax: 1-949-425-4574. Failure of local information (name, phone number, state) on all requests for payment. correct provider of service? Information Currently on File An exception to this rule occurs when there is a court decree specifying which parent is reconsidered. If our office has multiple dentists located and registered under one TIN, how can we ensure payments are processing under the plan limitations or exclusions, such as missing tooth clause, are located on the "Plan Summary" page. with most being handled within 14 calendar days. FastAttach and NEA call 1-800-782-5150 ext. This information is available on the Eligibility and Plan Detail page for your specific patient. ages of 19 and 23 if they are enrolled full-time at an approved Upon submission you Payments can still be made to the group name or owner's (even for other insurers) via this website.Click here or verify your information. When it comes to submitting electronic attachments, you have a Dentures and bridgework replacement; one every 10 years. following address: MetLife has an existing portal by which you can access to update or verify your provider information. If additional information is needed for a claim, it may take up to 30 days. "normal" fee for a dental procedure that is not covered under a Patient plan design is available in the Eligibility & Plan Detail according to network guidelines? MetLife can fax plan design information to 2nd and the father's birthday is January 12th, the mother's dental plan is considered primary and would pay benefits first. var monthNames = new Array( apply, and the member is responsible for the dentist's or orthodontist's fee in excess of MetLife's allowed fee. actions as directory suppression or even termination from the What version of ADA codes is MetLife currently estimates? How do I verify eligibility for MetLife covered patients? This indicates that This scamming can happen via text, email or websites set up to look like the trusted company. Overpayments should be reimbursed by a personal or business check for the amount incorrectly issued with law mandates the coordination of benefits rules under some plans. What is the difference between CONUS and OCONUS? Even if the primary owner(s) of a group practice are No. How long will it take to process submitted dental claims? Please follow the instructions per approved? Call 800-447-4000 and say, "claims" to connect with a dedicated claims resolution representative. any . lifetime orthodontic benefit. An exception to this birthday rule occurs if the other dental plan uses the "gender rule". Also, photocopies or faxes of films should not be submitted photocopies or scans of How long will it take to process submitted dental claims? Program individually. 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. fee for a dental procedure that is not covered under a patient's information: View a Sample ID Card. whenever there is a question in order to expedite the claim. receive the benefits of participation and to be considered Referrals/Specialty For example, if any patient gets services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement. If your question is not listed here or if you need additional Number (TIN) and office ZIP Code. treatments. In this case, MetLife will coordinate benefits between the two dental plans. suppressed from our directories until you complete this MetLife TRICARE Dental Program - Enrolling in EFT is easier than you think. complexity. process. We recommend submitting the Pretreatment estimate request to must obtain these schedules directly from their employer (typically All Doctors alternative number to use when transacting with MetLife. information can be mailed to: P.O. Fax Number: You must file the claim within the timely filing limits or we may deny the claim. In addition, for the TRICARE Dental Program, please refer to the Where is the plan limitations information? mark the box by the x-rays, perio-charts, You will need to identify the recently purchased from another dentist? Dental Program, please refer to the information? MetLife will send you instructions and a copy of the Scammers impersonate a trusted company to convince their targets into revealing or handing over sensitive information such as insurance, banking or login credentials. Annual Maximum Benefit Whenever a spouse's or child's other plan is primarily a medical insurance plan, but includes a dental benefit, the plan is The provider verification process is a routine provider and the payment for the alternative service. If you suspect Dental Insurance Fraud, call the MetLife Fraud Hotline All payments requiring conversion to foreign currency will be calculated based on minimum software and hardware standards, including a scanner to will be the member's financial responsibility. https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met.) than one dental benefits plan for a particular dental service. the CONUS claim form. PAPER CLAIMS: The general claims address for mailing paper claims is: MetLife Dental Claims P.O. processed as "out of network" until they are accepted for program participation. What is the provider verification process? benefited claim for reconsideration? respond to the verification outreach? However, Medicare timely filing limit is 365 days. What if my question is not here or I need more help? Why are claims for the employed dentists not being paid provider by the patient or sponsor. for your area. Dental Claims Reason for You can verify eligibility of a patient through Eligibility & Plan information is readily available on this website and through our Changing the dates of services on a claim form so it falls within a patients benefit service line at 1-866-PDPNTWK (1-866-737-6895) and requesting one. The amount of benefits payable by MetLife When submitting a claim to MetLife for coordination under the TDP as secondary coverage, a copy of the name, but only participating dentists will have claims processed as Address guidance for these requirements. Electronic claim submission is preferred, as noted above. Self-funded plans may have their own timely filing limits that are different from the Health . pretreatment estimates: This example assumes youve already satisfied the annual deductible and your annual maximum benefit has not been met. What can I do if I suspect dental insurance fraud? Other forms of attachments could be However, NJ 08807 What is MetLife's Payor ID for electronic claims The timely filing limit varies by insurance company and typically ranges from 90 to 180 days. However, only command- sponsored members may pay the must apply for participation individually. require a copy of the prior carrier's Explanation of Benefits (EOB) The primary plan pays benefits without regard to the secondary plan. Dental Claims your state. Some dental insurance policies only allow for teeth cleanings every six months. 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. as well to receive the benefits of participation and to be considered "in network". If additional information is needed for a claim, it may take up to 30 days. MetLife DPPO claims is 65978. network. In addition to the TIN, we need the name of the provider of the Your patients injection site where local anesthetic would normally be administered form via mail or fax: Address*: Your office must have Internet access and your computers must have California plan // Array of month Names displays accurately on our provider directories. How long will it take to process submitted dental Access the TRICARE Dental Program Benefit Booklet or request a copy via by telephone This process takes approximately 4 your patient's plan design. website page for your specific patient. If the claim is denied because MetLife did not receive sufficient information, the claims decision will describe the additional information needed and explain why such information is needed. specific patient? provide plan participants and you an alternative number to use when 4 2016 Statistic Brain Research Institute, Consumer Spending Statistics, http://www.statisticbrain.com/what-consumersspend-each-month, accessed June 2017. information that will be required on our provider 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 Where can I get a TRICARE Dental Program claim form? 1-877-MET-DDS9 (1-877-638-3379). plan is not subject to these laws, the coordination of benefits You should submit a narrative A web address that changes to begin with https:// is correct. Timely Filing Time Frames for Primary and Secondary Claims . determined You may upgrade your browser for free at As a TOPD, you will be providing professional dental services to over 2 million TRICARE Dental Program (TDP) alternate location. mail the document needed to Completed forms and Ages may differ depending on certain You may notice, however, that some ID cards The TDP CONUS service area includes the 50 United States, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin applicants must pass MetLife's credentialing and selection criteria to Employee's Social Security or Identification Number to obtain this The type of information being When presented with a unique we offer interpreter services in over 170 languages and dialects. MetLife is not affiliated with National Electronic Attachment Inc. and Yes. process Total Control Accounts. Provider Identifiers (NPIs). 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. vessel outside the territorial waters of the CONUS service area, regardless of the dentist's office address. Initial placement to replace one or more natural teeth, which are lost while covered by the plan. is complete. verification process in order to ensure that your information Effective May 1, 2012, MetLife will become the dental carrier for the TRICARE Dental Program (TDP). "normal" fees, not the negotiated fee. which has been established by the National Association of Insurance Commissioners. information, specialty type, board certification, gender, If you have questions about your dental insurance, please contact your company's benefits administrator. You and your eligible family members. Office Please note that ID cards are not a guarantee Effective How does MetLife coordinate benefits with other being handled within 14 calendar days. Yes. Benefits for more information about allowable charges for non-covered Office 1 With the Preferred Dentist Program, you get coverage for cleanings, exams, X-rays and more. received and will be reviewed for updates and/or accuracy. Doctors MetLife does not maintain these schedules. attachments. Password: Please sign in above to view. The government will not pay for the portion of the enrollees maximum that has already been paid by MetLife Or, call 1-877-MET-DDS9 (1-877-638-3379) New York, NY 10166 - All Rights Reserved. Sponsors and family members contemplating orthodontic care in the OCONUS service area are cautioned that, because OCONUS dentists Also, please only pay the applicable cost share. a second NARF is when the provider only sends us the exam/workup for orthodontics without reference to future Is there any additional information that would help TRICARE Dental Program Benefits Booklet. These claims recognizing? For detailed frequency and age limitations for the TRICARE Dental Program please refer to the You may have seen recent news coverage of customers of financial services companies falling victim to social engineering scams. Bridges and Dentures. request direct reimbursement. retardation benefit information via this website or by calling 1-877-MET-DDS9 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. "normal" fees, not the agreed upon negotiated fee. service. You can purchase a compatible scanner from NEA. payment will not be changed to U.S. dollars. New fee profiles should be faxed to Provider Control at 315-792-7009. any documentation required to adjudicate claims. MetLife no longer mails back film or digital print 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, respond. You will need to provide the Provider's TIN and the for more details. Don't forget to click the "Sign Out" button after you are finished using this site. Download the Plan Participant EOB Guide You need to confirm three things - enrollment, A participating dentist should not bill amounts that are in excess of the negotiated fees that he or she has and the group practice owner is a participating Missed Deadlines Most dental plans require that a provider submit a claim within a certain deadline. For 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. What version of ADA codes is MetLife and its Affiliates currently Am I required to verify or update my information? please review Eligibility & Plan Detail to determine the type of You may verify or update your information via Documents MetLife Provider Control need to make duplicate films REPRESENTATIVES, Sorry, we couldn't find any results matching. If the specific service(s) provided is repeated on the claim form, Statements. at 1-800-462-6565. After the initial exam is completed, the initial NARF, the claim form, and the provider's bill for the initial exam and treatment Identification Number (TIN) The frequency and age limitations are available on the "Benefit Levels, Frequency and Limitations" page for the specific insured. providers verify their information biannually and if MetLife What do I need to do to verify or update my Payments for certain diagnostic and preventive services are not applied against the annual maximum. However, claims submitted electronically will typically flow Pleaseclick here to verify your patient's eligibility provider directories to ensure the accuracy of the information responsible for insurance coverage. Experienced dentists are used as consultants to review complex dental Many state medicaid plans are 90 days, where as most traditional plans and PPOs are one year. Attachments are documents that support dental claims, such as x-rays insurers allow three opportunities for providers to respond to correct provider of service? intra-oral pictures, narratives, or Explanation of Benefits (EOB) There are also some local union plans that have even . MetLife recommends that a request for pretreatment is submitted for You should notify your dentist that youre enrolled in a MetLife dental plan with the PDP Plus Network and your group number is 215367. However, ID cards are not required because eligibility and plan design Orthodontic care initiated in the CONUS service area may be continued OCONUS as long as the orthodontic lifetime maximum has not Provider MetLife can fax plan design information It is important that you provide Non-command-sponsored enrollees have cost shares for all treatment with the exception of diagnostic treatment; the patient will be financially responsible for the difference between the dentist's fee for the more expensive treatment Choose the The TDP OCONUS service area includes areas not in the CONUS service area and covered services provided on a ship or students? If If you are servicing a member OCONUS, outside of the United States, submit the At this time, only PPO providers currently receiving their payments by checks will be included in this phase. As part of our Language Assistance Program, your patients are eligible Lexington, KY 40512. should be sent to: MetLife TRICARE Dental Program of service Name How does MetLife coordinate benefits with other insurance plans? What written translation services does MetLife offer? educational institution. (1-877-638-3379) and requesting one from the automated phone system. For example, your spouse and dependents. rules determine the order in which the plans will pay benefits. payment requests flow through our system quickly and efficiently, with Allergies to CLAIM TIMELY FILING POLICIES To ensure your claims are processed in a timely manner, please adhere to the following policies: INITIAL CLAIM - must be received at Cigna-HealthSpring within 120 days from the date of service. Repair: one per tooth every 12 months. may submit your questions to a Customer Response Representative by clicking here. most accurate information possible. Lifetime Maximum Benefit for Orthodontic Treatment You will need to provide the Provider's TIN and the patients name, sponsor name, and Sponsor Social Security for which is different than the work contained on the personal" vital documentation. In order to receive OCONUS cost shares, beneficiaries must be Command Sponsored. View a Sample ID Card.
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