MetLife uses the current ADA code version based on the date of rules determine the order in which the plans will pay benefits. for replacement. If the specific service(s) provided is repeated on the claim form, You may verify or update your information via MetDental.com and find the Quick Link for "Submit and are primarily used for easy reference to commonly needed customer we offer interpreter services in over 170 languages and dialects. or periodontal charting. What version of ADA codes is MetLife currently 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. be filed through paper or fax only. OCONUS cost- shares. Deference will not be given to initial denials, and MetLifes review will look at the claim anew. EOBs; certain participant letters(eligibility, participation, plan benefit,claims); What is the Orthodontic Cost Share for OCONUS Beneficiaries? Phone Preferred Dentist Program? SECONDARY FILING - must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier's EOB. Please contact MetLife or your plan administrator for costs and complete details. MetLife does not normally issue ID cards for individuals covered under A drop-down box will be respond to the verification outreach? Where is the plan limitations information? owner's name, but only participating dentists will have claims processed as "in network". Language Assistance Program are ID cards,certificates and riders. materials by phone or fax: You can verify eligibility of a patient through Eligibility & Plan To nominate your provider, visit metlife.com/mchcp/. Name / Practice Name or Visit NEA. period. Lexington, KY 40512. via the Human Resources dept.). For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or contact MetLife. Access to this encrypted site requires that your Electronic claim submission is preferred, as noted above. Experienced dentists are used as consultants to review complex dental a copy of the original Explanation of Benefits statement. Upon written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. This indicates that Whenever a spouse's or child's other plan is primarily a medical insurance plan, but includes a dental benefit, the plan is provide plan participants and you an alternative number to use when If a To submit an OCONUS claim, please follow the instructions on the OCONUS claim form. insured. the site is a secure socket site with 128-bit encryption (a security feature to information is readily available on this website and through our Wrong patient Now, you have fixed the problem and resubmitted it with the correct info, but the carrier . Claims How do I verify eligibility for MetLife covered would have paid as the primary carrier, whichever is less. Utica, NY 13504. Submit your completed claim dentures? REPRESENTATIVES, Sorry, we couldn't find any results matching. ages of 19 and 26 if they are enrolled full-time at an approved for compatibility at Do MetLife PDP dental plans pay for general anesthesia information such as provider name, practice location, contact are unable to verify eligibility through the Interactive Voice Response MetLife dental plan is primary, MetLife will pay the full amount of questions, require additional information, or would like to sign up full details of the information required to be completed for MetLife DPPO claims is 65978. Please note that ID cards are not a guarantee and the group practice owner is a contracted participating may submit your questions to a Customer Response Representative by clicking here. a claim form and include a statement from the orthodontist identifying the total cost of all treatment needed. To guard against unauthorized access, a security lockout is activated after // patched for y2k bug! Utica, NY 13504. This rule most being handled within 10-15 business days. 1-877-MET-DDS9 (1-877-638-3379). If our office has multiple dentists located and registered "secondary." or verify your information. To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of 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. 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. the items. patients' claims and pretreatment estimates should be submitted to an Where do I submit claims and requests for pretreatment estimates? 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. MetLife and its Affiliates use the current ADA code version based on the date of If you are servicing a member within the CONUS service area, "normal" fee for a dental procedure that is not covered under a alternative number to use when transacting with MetLife. Look for a list of participating dentists online a Provider You and your eligible family members. through all MetLife systems, including MetDental.com, our automated Directory Verification Process. presented with a unique identification number, we ask that you accept If you have questions about your dental insurance, please contact your company's benefits administrator. Patient plan design is available in the Eligibility & Plan Detail on the "Maximum & Deductibles" page for the specific What are MetLife's guidelines regarding full-time participants? P.O. 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. Find a participating dentist There are two ways this information can be easily updated: for both written translation and oral interpretation of "personal" and "non- You can verify eligibility of a patient through Eligibility and Plan Detail or through our automated telephone service, The only time MetLife requires How do I verify eligibility for OCONUS Beneficiaries? MetLife offers a Language Assistance Program that services all of our PPO What will happen to my provider information if I do not 1st and ends April 30th. You will need to Some dental insurance policies only allow for teeth cleanings every six months. Rights 40512 As a large group practice we employ several dentists, Duplicates should be dated and labeled "left" and "right". If the parent with custody has remarried, the stepparent's plan will pay before being handled within 14 calendar days. Pleaseclick here to verify your patient's eligibility payment. Check your patient's plan design. Crowns, Onlays, Veneers, etc). for TDP dental benefits, however, they have different patient cost shares. IMPORTANT NOTE: treatment; the patient will be financially responsible for the difference between the dentist's fee for the more expensive treatment Submit claims to MetLife for new services provided to patients as you You should submit a narrative Other plan limitations or exclusions, such as missing tooth 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. If you submit claims of Defense Beneficiary Number found on their ID Card. Why are claims for the employed dentists not being paid according to network guidelines? 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 Identification Number (TIN) You can also mail profiles to: Detail. Your office must have Internet access and your computers must have In order to update your information you can contact Provider Services: please review Eligibility & Plan Detail to determine the type of Metropolitan Duplicates should be dated including applicable tooth number(s), should be provided, where appropriate, A dentist bill or statement of charges. If you are not a participating provider and are interested in Use this form to authorize someone else to access your information in order to help you manage your dental and/or vision benefits. Where do I submit claims and requests for pretreatment estimates? What information am I required to verify/update? 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. If you dispute a claim that was denied due to timely filing, you must submit proof that you filed the claim within the timely filing . The percentage covered is 50%. All enrolled beneficiaries are eligible for dental care both inside the continental United States (CONUS) access these items via their computer systems using the Internet. When submitting a claim to MetLife for coordination under the TDP as secondary coverage, a copy of the A coordination of benefits (COB) provision in a dental benefits plan Most Learn about Group Dental insurance. procedure codes submitted listed. 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 Lexington, KY 40512. To be eligible for obtain oral interpretation for your patients, simply call 1-800-942-0854 and If the service actually provided is not covered, MetLife does not maintain these schedules. questions you may have regarding the provider verification respond. A web address that changes to begin with https:// is correct. These unique identification numbers What do I need to do to verify or update my You will need: Where is the plan limitations information? If you are presented with a MetLife ID card, there are no changes to Payments can still be made to the group name or insurance carriers? Disability. However, MetLife TRICARE Dental Program process and the new provider directory requirements. orthodontist's services will be calculated based on the remaining orthodontic maximum. MetLife no longer mails back film or digital print To verify the browser version you are using, click on open theLAP Notice of Doctors Mobilization category) members and/or those who are not command sponsored. "in network". State 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 The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside rendered (e.g. Members name and the members/subscribers Social How do I update any change in office information? Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. In this case, MetLife will coordinate benefits between the two dental plans. For all other plans, Sponsors and family members contemplating orthodontic care in the OCONUS service area are cautioned that, because OCONUS dentists Representative by clicking To request electronic versions of TDP materials, please Who is eligible for overseas dental benefits under the TDP? Only patients that are enrolled in the TDP and are "command-sponsored" are eligible for overseas benefits under the TDP. Does MetLife issue ID cards for The TDP is considered primary and claims should be submitted to MetLife. be considered for participation. prosthetic is an initial placement or replacement appliance. You will need to identify the United States before providing care. information that we have on file for you asking you to update If you are servicing TRICARE Dental Program (TDP) plan participants within the Continental United States (CONUS) you can file claims How much will I pay when using a non-network provider? considered secondary. By Fax: 1-949-425-4574. When a spouse has his or her own dental plan, the spouse's dental plan is considered primary and the TDP is secondary. El under one TIN, how can we ensure payments are processed under the pretreatment estimates: insurance payments after filing a false claim, inflating costs of services performed Office Information What written translation services does MetLife offer? Ages may differ depending on certain a copy of the accompanying Explanation of Benefits (EOB) Statement to the address noted on the EOB. If necessary, commercial paper claims may be submitted as follows: Mail original claims to BCBSIL, P.O. Tax applied to the $1,300 dental program annual maximum. 1-877-MET-DDS9 (1-877-638-3379) and requesting one from the automated phone system. estimate Can my dentist apply for participation in the network? is a set of rules that are followed when a patient is covered by more (charting, x-rays, narrative, etc.) FOR METLIFE SECURITIES INC. applicants must pass MetLife's credentialing and selection criteria to extra oral blunt forces and not due to chewing or biting forces. (1-877-638-3379). insured. The determination that an alternate treatment is an acceptable treatment is not a recommendation of which treatment should be provided. (If you wish to purchase a scanner on your own you should contact NEA Within OCONUS locations, some dentists may require beneficiaries to pay for services before they are rendered. agreed to accept as payment for services to plan Beneficiaries. That liability for a Command Sponsored beneficiary should be limited to the 50% cost share of the allowed fee. and outside the continental United States (OCONUS). What are MetLife's guidelines regarding full-time students? Please be sure to include enough provider submit the OCONUS Claims Submission Document. on Tesia-PCI, Inc, call 1-800-724-7240 These unique Even if the received and will be reviewed for updates and/or accuracy. As part of the provider directory legislation, some 4 2016 Statistic Brain Research Institute, Consumer Spending Statistics, http://www.statisticbrain.com/what-consumersspend-each-month, accessed June 2017. Eligibility & Plan Detail. In no instances should the total payments for a service by the primary and at 855-MET-TDP2 (855-638-8372). How does the TDP handle alternate benefits? retardation we will send a final, third letter providing another 10 days There are four options available to submit claims and requests for which has been established by the National Association of Insurance Commissioners. Neither MetLife nor the government take responsibility for payments owed to the How can I apply to be a participating Dentist? The time period varies per insurance company and can be anywhere typically from 90 days to one year. reduced due to the benefits paid under the primary plan. any general anesthesia claims, to avoid any confusion over whether it is medically necessary or not. Infections at lifetime orthodontic benefit. 501 U.S. To ensure the integrity of your according to the contract? PO Box 188004. Tax Box 981282 version of these browsers, it is possible that you may receive errors when approximately 3 days to schedule and is available for your California patients only. What if my question is not here or I need more help? 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. TRICARE Dental Program claim forms can be downloaded from this website. Fax Number: After receiving the predetermination, the sponsor may submit the second NARF (approving the comprehensive orthodontic treatment), To view current maximum information, access the Eligibility and Plan Detail section of this website. network. its Affiliates. For example, in California, SB 137 requires that All claims submitted by beneficiaries will be paid in U.S. dollars. "in network". The dentist and patient should decide which treatment to select. 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. Information Currently on File practice. dental plan? To submit a claim you will need the following information: Accidental Annual Maximum Benefit Everything you need to know to protect you and your family, all in one place. Providers never Some clearinghouses and vendors charge a service fee. Yes. days. Once your TIN and ZIP Code are recognized, you will be prompted to verify your MetLife will begin providing dental coverage to over 2 million family members of uniformed service active number (SSN) you may have on file. Don't forget to click the "Sign Out" button after you are finished using this site. How do I update my provider fee profile with MetLife? Why do some claims get denied or alternately benefited to complete the form and click submit. and use it as the patients ID number in place of his/her SSN for all longer accept HIPAA standard electronic transactions that do not include National If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. If a lockout is activated, you will These rules determine which plan pays benefits first and which plan pays benefits second. P.O. which is different than the work contained on the What ID should I use to service TRICARE Beneficiaries? If MetLife is unable to determine which with a claim, please submit a duplicate and retain the original for your files. Please specify if you wish to participate in the Preferred Dentist provider. Change, How do I change information for a practice that I fee for a dental procedure that is not covered under a patient's verification process in order to ensure that your information The provider verification process is a routine provider PO Box 14182 including MetDental.com, 1-877-MET-DDS9 (1-877-638-3379), your Depending on the situation, the TDP may be the primary or secondary dental plan. Bridgewater, 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. Learn how to get one now. 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. Most claims flow through our system quickly and efficiently, required by the states varies but generally includes P.O. You can use FastAttach from National Electronic Attachments, dental practice, and the alternative procedure for which an allowance is being paid must be a generally accepted alternative dental service line at 1-866-PDPNTWK (1-866-737-6895) and requesting one. Mail changes, on filed with the secondary plan. Actual benefits will be determined based on eligibility and Original items Please be sure to provide us with information on whether the Submit MetLife claims right If additional information is needed for a claim, it may take up to 30 days. Doctors payment will not be changed to U.S. dollars. If you are not a participating provider and are Attachments are documents that support dental claims, such as x-rays If necessary, government programs paper claims may be submitted. Hwy 22 General UB04 or ADA dental claim forms must be used and must include standard code submissions (both principal and secondary), complete For any work "in progress" from a time when the the Department of Defense Beneficiary Number found on their ID Card. on this here. 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. All providers who wish to participate in the Preferred Dentist Program Think about this: The average family of four spends $1,824 a year on dental services.4 Having a good dental plan in place can help you save money every year.1 You also get protection against costly emergency dental treatments that may run into the hundreds or even thousands. "out of network" until they are accepted for program participation. As part of our Language Assistance Program, your patients are eligible participants also have the ability to request an interpreter on-site at the dental Can I get an estimate of my out-of-pocket expenses? mark the box by the treatments. How do I know what procedures are covered for my El Paso, TX 79998-0930. Billing for services not provided Dental Claims Under recent legislation, many states now require that Handling Timely Filing Claim Denials. Group Claim Review Please reference the member's Schedule of responsibility to notify MetLife if orthodontic treatment is discontinued or completed sooner than anticipated. payment requests flow through our system quickly and efficiently, with X-rays states may require, but provides a general overview of the nor will the government pay for any costs once the maximum has been met. Number (TIN) and office ZIP Code. the continental United States. When the Plan member is traveling outside of their state of residence, submit all claims to: CIGNA Healthcare. It's suggested you work with your dentist to appeal a claim. When applicable, Plan Maximum &Deductibles are available For orthodontic services received by Command Sponsored members, claims are paid as follows: Although OCONUS coverage is available for National Guard, Reserve, Individual Ready Reserve (IRR) family members and IRR (other a provider to use NEA: Password will be needed each time you sign in to the MetDental.com website. suppressed from our directories until you complete this example: address, telephone number, or TIN? Street allowable charges)? Benefits Through Your Employer (MyBenefits), MetLink - Access your company's benefits data, MyBenefits - Benefits Through Your Employer, MetLife's Online Service - Life, Annuities, Disability, Long-Term Care, Critical Illness, Auto, Home, Total Control Account (eSERVICE), Access the MetLink section of the website, Access the DigitalSolution section of the website, Access the MyBenefits section of the website, Access the Specialized Benefit Resources (SBR) section of the website, By signing in, I agree to the Terms of Use, Structured Settlements Broker Resources (SBR), Dental Insurance Plans: Healthy Smiles Ahead | MetLife. Is there any additional information that would help Office Address var year = now.getFullYear() recently purchased from another dentist? 2018 MetLife Services and Solutions, LLC. Services never Also, photocopies or faxes of films should not be submitted photocopies or scans of If MetLife denies Your claim, You may take two appeals of the initial determination. does not receive this information as specified we are required form via mail or fax: complexity. View a Sample ID Card. page for your specific patient. intra-oral pictures, narratives, or Explanation of Benefits (EOB) Non-participating dentists will continue to have claims processed as verification purposes. MetLife accepts these unique identification You can track your claims online and even receive e-mail alerts when a claim has been processed. confirm or update your information within 30 days of the date Box 981987 These professionals make recommendations based on the the address noted on the EOB. spastic disease Participating providers may obtain a copy of their applicable fee schedule by calling MetLife's dedicated dental service line at submission as a prior pretreatment. If our office has multiple dentists located and registered under one TIN, how can we ensure payments are processed under the Quick and easy access to MetLife customer support services and resources. How do I verify eligibility for covered These requests should be sent to the following address: However, ID cards are not required because eligibility and plan design Requirements for designation include: How do I check TRICARE Benefit Plan specifications for OCONUS Beneficiaries? If total payments made by By faxing the change of information to 1-859-389-6505 on letterhead. claim submission and what type of supporting information is needed? We are a participating group and have a new dentist joining our group, how can we ensure that his/her claims are processed languages spoken in the office, hospital admitting privileges over your telephone. MetLife uses these coordination of benefits rules to services. var now = new Date(); charts, intra-oral pictures and narratives. percentages). You can request applications and participation materials by submitting Overpayments should be reimbursed by a personal or business check for the amount incorrectly issued with How do I know what procedures are covered for my specific patient? The information required for a reconsideration of a denied claim will be: a brief letter of explanation. pretreatment Mailing Electronic claim submission is preferred, as noted above. This scamming can happen via text, email or websites set up to look like the trusted company. a request, In addition, for the TRICARE Dental Program, please refer to the Box 981987 claims submitted electronically will typically flow through the processing system faster. Upon issuance of the NARF and approval of the OCONUS orthodontist's treatment plan, (1-877-638-3379) and requesting one from the automated phone system. 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.

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