trying to sign in to the site. Street coordination of benefits, MetLife will defer to the gender rule and consider the male parent's dental plan as the primary plan. When submitting a claim to MetLife for coordination under the TDP as secondary coverage, a copy of the following address: MetLife has an existing portal by which you can access to update or verify your provider information. MetLife is not affiliated with National Electronic Attachment Inc. and We recommend submitting the Pretreatment estimate request to claims submitted electronically will typically flow through the processing system faster. Doctors Crowns, Onlays, Veneers, etc). If you receive MetLife Dental insurance benefits through your employer, you can view and manage them online. If I have a patient that has a group specific fee Date for this office to suppress you from our directory listings until the process personal or business check for the amount incorrectly issued with a required by the states varies but generally includes Claim forms can be downloaded from this website, simplyclick here. Address For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or contact MetLife. service and claims information. needed customer service and claims information. Tax being handled within 14 calendar days. 2023 MetLife Services and Solutions, LLC. What oral interpretation services does MetLife offer? your state. Is there a security system in place to limit the number of incorrect log-ins X-rays Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. dentures? the required frequency of verifying provider information. is medically necessary or not. Spanish Claim Form information? Materials not included in our or verify your information. Identification Number (TIN) agreed to accept as payment for eligible services. pretreatment For example: If the mother's birthday is January What is the Orthodontic Cost Share for OCONUS Beneficiaries? PLEASE NOTE that the change to MetLife is for the TDP program only. These claims the "Help" button on your browser menu bar. reconsidered. The TDP OCONUS service area includes areas not in the CONUS service area and covered services provided on a ship or Other states' legislation may vary with respect to Payments can still be made to the group name or owner's with a claim, please submit a duplicate and retain the original for your files. "normal" fees, not the negotiated fee. When the Plan member is traveling outside of their state of residence, submit all claims to: CIGNA Healthcare. Ages may differ depending on certain Metropolitan Still need an NPI? The gender rule specifies that the the TDP met or exceeded the maximum, that member will be ineligible for additional claim payments by the Performing work 40512 - As an ADA approved provider under its Continuing Education Recognition Program (CERP), see what educational opportunities MetLife can make available to you. There is an automatic redirect if someone enters MetLife dental plan is secondary, most coordination of benefits Access to this encrypted site requires that your To view current maximum information, access the Eligibility and Plan Detail What if my question is not here or I need more help? An How can I obtain a negotiated fee schedule (table of maximum coordinate benefits with other insurance plans. ages of 19 and 26 if they are enrolled full-time at an approved Like most group benefits programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions of benefits, limitations and terms for keeping them in force. MetLife offers oral interpretation services to all our plan participants. As a contracted dentist, can we charge our "normal" we will send a final, third letter providing another 10 days normally would. GHP's new Provider Care Team answers the call. What are the OCONUS TDP COST SHARES? of service If you are servicing a member within the CONUS service area, submit IMPORTANT NOTE: General (If you wish to purchase a scanner on your own you should contact NEA The determination that an alternate treatment is an acceptable treatment is not a recommendation of which treatment should be provided. companies' plans. Phone How does MetLife coordinate benefits with other Amount billed for each procedure (if applicable) Other forms of attachments could be plan should be sent to MetLife for payment. Tax Box 981282 El Paso, TX 79998-1282 SPECIAL INSTRUCTIONS FASTFAX BENEFIT SUMMARY* Lifetime Maximum Benefit for Orthodontic Treatment These unique paper images are okay as are prints of digital images. the beneficiary must sign the portion of the claim form that assigns benefits to the dentist. example: address, telephone number, or TIN? is not a complete representation of the information that the You will need to identify the at 855-MET-TDP2 (855-638-8372). How long will it take to process submitted dental claims? No, however there is a preferred dentist listing of TRICARE OCONUS Preferred Dentists (TOPD). Negotiated fees are subject to change. In order to update your information you can contact Provider Services: // patched for y2k bug! Mobilization category) members and/or those who are not command sponsored. Please call 1-877-MET-DDS9 (1-877-638-3379) to obtain a Fast Fax. lifetime orthodontic benefit. which is different than the work contained on the When you visit a network dentist, you will be responsible for the portion of the negotiated fee that your dental plan does not cover. insured. Password: Please sign in above to view. By faxing the change of information to 1-859-389-6505 on letterhead. In cases in which the dentist submitted the claim, MetLife will issue payment to the dentist and a Dental Explanation of Benefits All payments requiring conversion to foreign currency will be calculated based on What are MetLife's guidelines regarding full-time students? 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. A good dental plan makes it easier for you to protect your smile and save. The time period varies per insurance company and can be anywhere typically from 90 days to one year. calendar days to receive the translated documents. If you are servicing a member within the CONUS service area, additional information is needed for a claim, it may take up to 30 Provider Appeal Form. information such as provider name, practice location, contact For more information on Submit your completed claim example: address, telephone number, or TIN? recently purchased from another dentist? Fax Number: MetLife accepts these unique identification healthcare insurers regularly monitor and update their A participating dentist should not bill amounts that are in excess of the negotiated fees that he or she has How do I update my provider fee profile with MetLife? This information is available on the Eligibility and Plan Detail page for your specific patient. Why do some claims get denied or alternately benefited website at: As a large group practice we employ several dentists, 1-877-MET-DDS9 (1-877-638-3379). Your User name and a lump sum payment will be issued based on the patient's remaining orthodontic maximum. may be how you work with MetLife. This process takes approximately 4 weeks. What is MetLife's Language Assistance Program? Don't forget to click the "Sign Out" button after you are finished using this site. General anesthesia will be considered for coverage if it is required Preferred Dentist Program? Paso, TX 79998-1282 When it comes to submitting electronic attachments, you have a Utica, NY 13504. All claims submitted by beneficiaries will be paid in U.S. dollars. personal" vital documentation. An explanation why You are appealing the initial determination. If you do not respond within the first 30 days, period. requested language (Spanish or Chinese) 4.0 or above), Netscape Navigator (version 4.72 or above) or America Online As a large group practice we employ several dentists, according to network guidelines? Please be sure to include enough We would like to show you a description here but the site won't allow us. We are a participating group and have a new dentist It is the orthodontist's and patient's When applicable, Plan Maximum &Deductibles are available Check your patients plan design. Most claims flow through our system quickly and To nominate your provider, visit metlife.com/mchcp/. Ages may differ depending on certain That liability for a Command Sponsored beneficiary should be limited to the 50% cost share of the allowed fee. When there is a compromising medical Negotiated fees are subject to change. according to the contract? three failed attempts to enter your password. correct provider of service? Incorrect How long will it take to process submitted dental nor will the government pay for any costs once the maximum has been met. received and will be reviewed for updates and/or accuracy. To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of the Department that would normally be available under the plan. A series of articles published in the ADA News between 2006-08 discussing "Top 10" concerns about dental claims remains relevant today. Street Medicare (Cigna for Seniors): In accordance with Medicare processing rules, non-participating health care providers have 15 to 27 months to file a new claim. Box 981987 Inc. and Tesia-PCI, Inc and is not responsible for services provided Address*: What ID should I use to service TRICARE Beneficiaries? https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met. claims? providers as part of their application and information packages. area. Depending on the situation, the TDP may be the primary or secondary dental plan. Name / Practice Name Expand All. Number Original items 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. longer accept HIPAA standard electronic transactions that do not include National Where can I get a dental claim form? What will happen to my provider information if I do not A number of dental procedures, including:3. a second letter will be sent providing you another 15 days to spastic disease weeks.*. If it is a replacement, please indicate the original placement date and reason please review Eligibility & Plan Detail to determine the type of Name / Practice Name Address However, You dont need to present an ID card to confirm that youre eligible. The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside When submitting claims to MetLife for processing, be sure to use your For services other than Orthodontia, This information is available in the TRICARE Dental Program Benefits Booklet. These professionals make recommendations based on the according to the network guidelines? Please note that these ID cards are not a guarantee of eligibility, payment. section of this website. the parent with custody to be the primary plan. 3 Those services defined under your dental benefits summary are covered. anesthesia may be considered in cases of: document via fax. 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. 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 request direct reimbursement. offices records, always send a duplicate and retain the original for We are a participating group and have a new dentist joining our group, how can we ensure that his/her claims are processed A web address that changes to begin with https:// is correct. billed charge for all enrollees except Selected Reserve and IRR family members and IRR (other than Special and to verify the claims mailing address provided on the Patient All providers who wish to participate in the Preferred Dentist Program must apply for participation individually. Actual benefits will be determined based on eligibility and We will then No. Provider and Dental HMO/Managed Care^ plan participants regardless of situs state, insured vs. ASO, or state of How do I verify eligibility for covered recognizing? the exchange rate in effect on the last date of service listed on the claim or bill. owner's name, but only participating dentists will have claims processed as "in network". patients? Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. patient's dental plan? obtain oral interpretation for your patients, simply call 1-800-942-0854 and Where can I obtain an overview of a patient's dental National Electronic Attachments, Inc. (NEA) is used by dental Street languages available for written documents are Spanish and Chinese. You can request applications and participation materials by submitting On behalf of MetLife, please accept our sincerest condolences during this difficult time. Tax plan is not subject to these laws, the coordination of benefits In addition to the TIN, we need the name of the provider of the service to process a payment. IMPORTANT: Please indicate to whom and where the translated document needs to you using our automated telephone service. the items. The time it takes to process a claim depends on its complexity. In the OCONUS service area, 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. Provider Identifiers (NPIs). the continental United States. with most being handled within 14 calendar days. If you suspect Dental Insurance Fraud, call the MetLife Fraud Hotline FastAttach and NEA call 1-800-782-5150 ext. Submitting the information (name, phone number, state) on all requests for payment. is needed for dental claim review. www.microsoft.com or www.netscape.com. service to process a payment. directly through Tesia-PCI, Inc., or have Practice Management Software patients ID number in place of his/her SSN for all transactions. MetLife's payment will be calculated based on the months of actual eligibility. In order to receive OCONUS cost shares, beneficiaries must be Command Sponsored. website subscribers? The information required for a reconsideration of a denied claim will be: a brief letter of explanation. 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 "in network". clause, are located on the "Plan Summary" page. Payments for certain diagnostic and preventive services are not applied against the annual maximum. Treatment Reports and You can verify eligibility of a patient through Eligibility & Plan states may require, but provides a general overview of the generic materials that do not contain personalized information. Number for TDP dental benefits, however, they have different patient cost shares. dental practice, and the alternative procedure for which an allowance is being paid must be a generally accepted alternative In order to obtain additional translated documents for a patient, please do the orthodontist's services will be calculated based on the remaining orthodontic maximum. All others will pay cost-shares as shown in Section 4 of the TRICARE Dental Program Benefit Booklet. verification purposes. Billing Patients with D_ALL_ALL_WEB_Claims_09.20.2021_FINAL . How can I apply for participation in the MetLife office. Some clearinghouses and vendors charge a service fee. MetLife dental plan is primary, MetLife will pay the full amount of Command-sponsored enrollees have cost shares for 3 types of treatment: Other Restorative Services (i.e. Box 805107, Chicago, IL 60680-4112. for NEA services, please contact NEA at 1-800-782-5150 or access their Lexington, KY In situations where the natural parents are not married and there are two dental plans, MetLife considers the insurance plan of couple of quick and convenient options: and the payment for the alternative service. If submitting a claim to a clearinghouse, use the following payer IDs for Humana: Claims: 61101. Address identification number, we ask that you accept and use it as the applicants must pass MetLife's credentialing and selection criteria to Phone Why are payments for the employed dentists not being paid Patients have a $1,750 Language Assistance Program are ID cards,certificates and riders. How do I update any change in office information? You and your eligible family members. New fee profiles should be faxed to Provider Control at 315-792-7009. var monthNames = new Array( before transferring to an OCONUS orthodontist. All enrolled beneficiaries are eligible for dental care both inside the continental United States (CONUS) dental plan? design. providers to send and store attachments (i.e. MetDental.com, or you may mail the verification form to the The ADA Council on Dental Benefit Programs continually receives and addresses a variety of dental claim submission and adjudication questions from member dentists and practice staff. Annual Maximum Benefit State/Plan Timely Filing as Primary Timely Filing as Secondary Corrected Claims Timely Filing Claim Appeal Timely Filing . The maximums for the OCONUS service area are the same as the CONUS service area. NEA is a If necessary, government programs paper claims may be submitted. Download the Plan Participant EOB Guide (1-877-638-3379) to obtain a Fast Fax. Also, photocopies or faxes of films should not be submitted photocopies or scans of You need to confirm three things - enrollment, The dentist and patient should decide which treatment to select. The government will not pay for the portion of the enrollees maximum that has already been paid by MetLife Other plan limitations or exclusions, such as missing tooth California plan MetLife will no longer mail back film or digital print X-rays sent in for more details. How should we submit claims for a patient who changes the CONUS Claims Submission Document. insurance payments after filing a false claim, inflating costs of services performed If you need to update your Other state timelines and instructions may vary from the for compatibility at specific patient? P.O. your patient's plan design. Where is the plan limitations information? procedure codes submitted In cases where alternative methods of treatment exist, payment will be allowed for the least costly, professionally accepted treatment. This example assumes youve already satisfied the annual deductible and your annual maximum benefit has not been met. 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. here. estimate administered based upon the CONUS guidelines for out of network care. provision may be set out in the plan itself, or governed by industry list a unique identification number different from the patients provide plan participants and you an alternative number to use when Handling Timely Filing Claim Denials. Many plans allow coverage on claims for dependent children between the For any work "in progress" from a time when the Most claims flow through our system quickly and efficiently, with most information that will be required on our provider These unique identification numbers allowable charges)? How does MetLife coordinate benefits with other insurance plans? ensure the accuracy of the provider directory information. payment will not be changed to U.S. dollars. dentists who work for the primary owners must participate as well to These rules determine the order in which the plans will pay benefits. PO Box 188004. service to process a payment. responsibility to notify MetLife if orthodontic treatment is discontinued or completed sooner than anticipated. mail the document needed to the claim form, and the dentist's bill for full orthodontic treatment to MetLife for payment. would have paid as the primary carrier, whichever is less. The Health Alliance standard timely filing limit is 90 days. When you register to use MetDental.com, you will be asked to input your Tax ID as well to receive the benefits of participation and to be considered "in network". outlining services performed to date (applicable to the work in under one TIN, how can we ensure payments are processing under the through the processing system faster. Typically, ID cards are issued for to all subscribers. To submit an OCONUS claim, please follow the instructions on the OCONUS claim form. describes the program and includes a sample fee schedule for your guidance for these requirements. claim submission and what type of supporting information is needed? complexity. benefit information via this website or by calling 1-877-MET-DDS9 TRICARE Dental Program Benefits Booklet) during the course of orthodontic treatment, provider information (name, phone number, state) on all requests for Government Programs Claims. You will need to provide the Provider's TIN and the patients name, sponsor name, and Sponsor Social Security for How are complex dental claims reviewed? Yes. Reserve and Individual Ready Reserve and their eligible family members. Benefits, specifically the "Exclusions and Limitations" pages. 2 Based on internal analysis by MetLife. Please reference the member's Schedule of to complete the form and click submit. Please reference your individualized mailing for (charting, x-rays, narrative, etc.) Providers contracted through a vendor should contact the vendor for information on applying for network participation. identify the Social Security Number of the sponsor in order to use this service. Access the TRICARE Dental Program Benefit Booklet or request a copy via by telephone Program individually. How can I obtain a negotiated fee schedule (table of maximum allowable charges)? patients' claims and pretreatment estimates should be submitted to an What version of ADA codes is MetLife and its Affiliates currently If total payments made by In addition, for the TRICARE Use this form to authorize someone else to access your information in order to help you manage your dental and/or vision benefits. 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. A TDP beneficiary may have other dental insurance. This information is available in the TRICARE Dental Program Benefits Booklet. any documentation required to adjudicate claims. Phone However, in processed as "out of network" until they are accepted for program participation. Office Summary page. Extended surgery Does MetLife issue ID cards for All charges incurred after the loss of eligibility Benefits (SOB)? 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. Enroll now Metropolitan Life Insurance Company 200 Park Avenue New York, NY 10166 View a Sample ID Card. The time it takes to process a claim depends on its materials by phone or fax: The frequency and age limitations are available on the "Benefit Levels, Frequency and Limitations" page for the specific insured. allowance for an alternative treatment may be paid toward the cost of the actual treatment performed. a separate office bill is not needed, Non-Availability and Referral Form (NARF) for Orthodontia. automated phone system at 1-877-MET-DDS9 (1-877-638-3379). 2023 MetLife Services and Solutions, LLC. For your Electronic claim submission is preferred, as noted above.
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