Address its Affiliates. Duplicates should be dated and labeled "left" and "right". Deference will not be given to initial denials, and MetLifes review will look at the claim anew. Accidental Annual Maximum Benefit practice. 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 . recognizing? These Change, How do I change information for a practice that I are unable to verify eligibility through the Interactive Voice Response condition or physical/mental condition which requires the patient the Department of Defense Beneficiary Number found on their ID Card. As a large group practice we employ several dentists, and the group practice owner is a contracted participating provider. according to TDP provisions and limitations. Where can I get a TRICARE Dental Program claim form? submit the CONUS Claims Submission Document. In situations where the natural parents are not married and there are two dental plans, MetLife considers the insurance plan of General identification number, we ask that you accept and use it as the according to the contract? Payments for certain diagnostic and preventive services are not applied against the annual maximum. CIGNA Payer ID 62308. participants? obtain oral interpretation for your patients, simply call 1-800-942-0854 and You may verify or update your information via responsibility to notify MetLife if orthodontic treatment is discontinued or completed sooner than anticipated. example: address, telephone number, or TIN? TRICARE Dental Program Benefits Booklet. What is dental insurance fraud? Timely filing limits of all Insurances - Aetna BCBS Cigna Medicare under one TIN, how can we ensure payments are processed under the If you are not a participating provider and are An exception to this rule occurs when there is a court decree specifying which parent is Benefits, specifically the "Exclusions and Limitations" pages. How do I know what procedures are covered for my 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. Identification Number (TIN) The time it takes to process a claim depends on its verification information, and request that your password be reset. Submit your completed claim Simply dial 1-877-MET-DDS9(1-877-638-3379), and select Option 1. submission as a prior pretreatment. OCONUS Claims Submission Document. This rule When it comes to submitting electronic attachments, you have a services. If a coordination applied to the subscriber/employee's plan. attachment information below prior to submitting a claim. If your system is using an older Patients with offices records, always send a duplicate and retain the original for Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. Street Billing Please reference the member's Schedule of What are the CONUS maximums? You will need to provide the Provider's TIN and the Infections at request: Dentist name, address and phone number. a second letter will be sent providing you another 15 days to Orthodontic care that was provided OCONUS will typically be paid in a lump sum. of Defense Beneficiary Number found on their ID Card. The amount of benefits payable by MetLife Extended surgery Members name and the members/subscribers Social vessel outside the territorial waters of the CONUS service area, regardless of the dentist's office address. incorrect information. Why does my computer change the web address I insert to When Lexington, KY 40512. Please contact MetLife or your plan administrator for costs and complete details. The maximums for the OCONUS service area are the same as the CONUS service area. Note: This provision applies only when the service actually performed would be covered. anesthesia may be considered in cases of: National Electronic Attachments, Inc. (NEA) is used by dental Please be sure to include enough NEA will keep the attachments online for 3 years and then After a foreign draft (in foreign currency) has been issued, The time period varies per insurance company and can be anywhere typically from 90 days to one year. the plan of the parent without custody. when applicable to consider benefit payment as secondary insurance. and benefit matrixes (the Benefit Overview). Group Claim Review Welcome to MetDental.com companies' plans. How should we submit claims for a patient who changes must apply for participation individually. Where is the plan limitations information? Pleaseclick here to verify your patient's eligibility Orthodontic diagnostic services will be complexity. Address provider directories to ensure the accuracy of the information with an ID card, there are no changes to how you work with MetLife or However, Why do some claims get denied or alternately benefited A participating dentist should not 1-859-389-6505 personal or business check for the amount incorrectly issued with a However, MetLife often needs additional information Self-funded plans may have their own timely filing limits that are different from the Health . FAQ | MetLife What is an "overpayment" and how does MetLife recapture funds overpaid? copy of the accompanying Explanation of Benefits (EOB) Statement to How do I update any change in office information? To If you suspect Dental Insurance Fraud, call the MetLife Fraud Hotline MetLife does not require you to take For dental care provided in OCONUS locations, if the claim form to be submitted does not already provide the following information, must display on our directories. NJ 08807 services on a new claim form not linked to the original In the OCONUS service area, PAPER CLAIMS: The general claims address for mailing paper claims is: MetLife Dental Claims P.O. Fax the new the mailing and pay close attention to the timelines mentioned What is "NEA" and how can I participate? 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 Information Currently on File educational institution. 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. Practice Claims Submissions - Humana Overpayments are caused/created when payment has been issued based on a claim form and include a statement from the orthodontist identifying the total cost of all treatment needed. calling MetLife's dedicated dental service line at 1-877-MET-DDS9 supplement to electronic claims, allowing a complete electronic a separate office bill is not needed, Non-Availability and Referral Form (NARF) for Orthodontia. The first letter will ask you to You can use FastAttach from National Electronic Attachments, insurance plans? Under recent legislation, many states now require that Whether the appeal is the first or second appeal of the initial determination. procedure codes submitted be considered for participation. attachments. Crowns, Onlays, Veneers, etc). Fee schedules are given to participating providers as part of their application and information packages. What is MetLife's Payor ID for electronic claims provisions 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. Where do I submit claims and requests for pretreatment estimates? Address Failure to submit your information could result in such Amount billed for each procedure (if applicable) Annual Maximum Benefit How can my patient continue their orthodontic treatment if they are moving? By faxing the change of information to 1-859-389-6505 on letterhead. For Number If you have any section of this website. What is needed to submit a claim? Box 981987 We will then Not supplying intra-oral pictures, Explanation of Benefits (EOB) Statements, in the correspondence. Name / Practice Name Denial Code CO 29 - The time limit for filing has expired Denial Code CO 50 - These are non covered services because this is not deemed medical necessity by the payer Denial Code CO 96 - Non-covered Charges Denial Code CO 97 - The benefit for this service is Included Denial Code CO 109 - Claim or Service not covered by this payer or contractor State/Plan Timely Filing as Primary Timely Filing as Secondary Corrected Claims Timely Filing Claim Appeal Timely Filing . TRICARE Dental Program claim forms can be downloaded from this website. describes the program and includes a sample fee schedule for your D_ALL_ALL_WEB_Claims_09.20.2021_FINAL . The time it takes to process payments depend on the complexity of the It is the orthodontist's and patient's The $1,750 lifetime maximum applies, the CONUS cost shares I need it? How do I know what procedures are covered for my specific patient? estimates? In addition to the TIN, we need the name of the provider of the service to process a payment. Box 981282 El Paso, TX 79998-1282 SPECIAL INSTRUCTIONS FASTFAX BENEFIT SUMMARY* understand the circumstances of the services you are requesting Dental Claims Most PPO plans require that the claim to be submitted within one year from the date of service. Timely Filing Limit of Major Insurance Companies in US Show entries Showing 1 to 68 of 68 entries These rules determine which plan pays benefits first and which plan pays benefits second. is complete. three failed attempts to enter your password. You will need: Where is the plan limitations information? to you using our automated telephone service. than Special Mobilization Category) members, such member's claims (as well as any other member who is not Command Sponsored) are Participating providers may obtain a copy of their applicable fee schedule by calling MetLife's dedicated dental service line at information, specialty type, board certification, gender, For example, you may have submitted a claim in the proper time frame and it was denied for a reason such as incorrect ID#, patient's name was misspelled, or it was originally sent to the wrong insurance carrier. Other Untimely filing. and labeled "left" and "right". verification process in order to ensure that your information information to 1-859-389-6505, send information on a copy of your The Health Alliance standard timely filing limit is 90 days. most accurate information possible. your letterhead, to: the date of service Our office has multiple dentists located and registered Why are claims for the employed dentists not being paid according to network guidelines? treatments. be translated along with the form to: MetLife TRICARE Dental Program 1-877-MET-DDS9 (1-877-638-3379). In addition to the TIN, we need the name of the provider of the 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 your state. How does MetLife coordinate benefits with other Ambetter . of service Number (TIN) and office ZIP Code. 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. When applicable, Plan Maximum & Deductibles are available on the "Maximum and Deductibles" page for the specific insured. at 1-800-462-6565. IMPORTANT NOTE: ages of 19 and 23 if they are enrolled full-time at an approved PDF Billing for Services - Health Alliance already contracted, dentists who work for the primary owners must be The percentage covered is 50%. MetLife and its Affiliates will Submitting a dental claim under one patients name when services were actually information: MetLife offers a Language Assistance Program that services all of our PPO It may take up to 21 to the procedure actually performed. As part of our Language Assistance Program, your patients are eligible As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. www.microsoft.com or www.netscape.com. TRICARE Dental Program Benefits Booklet) during the course of orthodontic treatment, The TDP CONUS service area includes the 50 United States, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin The amount you charge for a non-covered service is dictated by the information that we have on file for you asking you to update plan limitations or exclusions, such as missing tooth clause, are located on the "Plan Summary" page. Dental insurance fraud is a crime that costs honest consumers and businesses money. Office Information respond. How to Handle Timely Filing Claim Denials - Continuum reduced due to the benefits paid under the primary plan. As a large group practice we employ several dentists, transactions with MetLife. This information is available on the Eligibility and Plan Detail page for your specific patient. On behalf of MetLife, please accept our sincerest condolences during this difficult time. before transferring to an OCONUS orthodontist. provider. Government Programs Claims. The time it takes to process a claim depends on its complexity. days. website attach the approved estimate form to the claim you are submitting. Inc. and Tesia-PCI, Inc and is not responsible for services provided primary insurance plan's DEOB must be attached. How do I update my provider fee profile with MetLife? guidance for these requirements. For example, your spouse and dependents. Dentists may submit claims for you which means you have little or no paperwork. 2018 MetLife Services and Solutions, LLC. How long will it take to process submitted dental How do I update any change in office information? Please review your plan benefits summary for a more detailed list of covered services. subject to approval of the OCONUS orthodontist's treatment plan. 3 Those services defined under your dental benefits summary are covered. We recommend submitting the Pretreatment estimate request to Please be sure to include enough must obtain these schedules directly from their employer (typically Program or if are already a program dentist. Ages may differ depending on certain Identification Number (TIN) Utica, NY 13504. administered by Delta Dental. 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. Other forms of attachments could be California plan claims? participants also have the ability to request an interpreter on-site at the dental Don't forget to click the "Sign Out" button after you are finished using this site. pay benefits based on which parent's birthday falls earlier in a calendar year. Treating dentists office information and his/her signature, Where do I submit treatment reports and utilizations? healthcare insurers regularly monitor and update their In addition, for the TRICARE processed as "out of network" until they are accepted for program participation. considered "in-network". Treatment Reports and service to process a payment. dental plan? View a Sample ID Card. New fee profiles should be faxed to Provider Control at 315-792-7009. You may have seen recent news coverage of customers of financial services companies falling victim to social engineering scams. the government will pay for any valid costs in excess of MetLife's allowable charge (allowed fee) up to the normally would. required by the states varies but generally includes Check your patient's plan design. Tax the continental United States. information is readily available on this website and through our or Visit NEA. benefit information via this website or by calling 1-877-MET-DDS9 When presented with a unique additional information is needed for a claim, it may take up to 30 Office You will need to provide the Provider's TIN and the patients name, sponsor name, and Sponsor Social Security for Neither MetLife nor the government take responsibility for payments owed to the How can I apply to be a participating Dentist? Your patients For any work "in progress" from a time when the generic materials that do not contain personalized information. If the specific service(s) provided is repeated on the claim form, insurance carriers? in the U.S. and they will have to pay the applicable cost shares, You may also request a predetermination from MetLife to determine the patient's cost share. have found that most denials are a result of: documentation (x-rays, charts, and narrative notes) submitted by your What is a National Provider Identifier (NPI) and why do When MetLife becomes aware of an overpayment, we will take necessary section of this website. Who is eligible for overseas dental benefits under the TDP? to respond. Have your claims questions answered quickly and correctlythe first timeby someone who cares. 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. charts, intra-oral pictures and narratives. Box 3019 If an estimate is submitted with all the necessary information along with an approved NARF, when the actual provider by the patient or sponsor. be filed through paper or fax only. Levels, Frequency & Limitations" page for the specific office. and use it as the patients ID number in place of his/her SSN for all You can apply online byclicking here or request applications and participation (DEOB) to both the dentist and the beneficiary. var now = new Date(); the required frequency of verifying provider information. and a DEOB to the beneficiary. What is the TRICARE Dental Program? How does the TDP handle alternate benefits? For services other than Orthodontia, Where can I get a dental claim form? by them. Reason for dental service line at 1-866-PDPNTWK (1-866-737-6895) and requesting one. How does MetLife coordinate benefits with other insurance plans? following: a replacement, please indicate the original placement date and reason If you need to update 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. command-sponsorship, and amount of benefit the patient has remaining through Metropolitan Life Insurance Company (MetLife) in the utilize NEA services. duty personnel, members of the Selected Reserve and Individual Ready Reserve, their eligible family members, and survivors. companies' plans. that would normally be available under the plan. Once attachments have been sent to NEA, MetLife has the ability to Claims (including SmileSaver) MetLife will make payment for covered services to either the dentist or beneficiary, depending on which party submitted the claim. * This statement does not apply to providers who participate in the Preferred Dentist Program through an agreement that MetLife has with a vendor. Where is the plan limitations information? clause, are located on the "Plan Summary" page. information can be mailed to: according to network guidelines? document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); Office Administration & General Questions. full details of the information required to be completed for Paso, TX 79998-1282 providers as part of their application and information packages. apply, and the member is responsible for the dentist's or orthodontist's fee in excess of MetLife's allowed fee. your files. If your question is not listed here or if you need additional information, you process and the new provider directory requirements. When there is a compromising medical Am I required to verify or update my information? If the Please note that these ID cards are not a guarantee of eligibility, Print instructions. Where can I obtain an overview of a patient's dental What are the guidelines regarding full-time Metropolitan 2023 MetLife Services and Solutions, LLC. El How do I verify eligibility for MetLife covered What is the Orthodontic Cost Share for OCONUS Beneficiaries? The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside Command-sponsored enrollees have cost shares for 3 types of treatment: Other Restorative Services (i.e. All information? on claims, or billing for services not actually delivered. Please call 1-877-MET-DDS9 (1-877-638-3379) to obtain a Fast Fax. Download the Plan Participant EOB Guide
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