To nominate your provider, visit metlife.com/mchcp/. - Enrolling in EFT is easier than you think. The time it takes to process a claim depends on its complexity. of the letter. View a Sample ID Card. Doctors Learn how to get one now. A web address that changes to begin with https:// is correct. Timely filing requirements are determined by the self-funded customer as well as the provider-contracted timely filing provisions. MetLife will review and provide the patient with a summary of the covered costs. 2018 MetLife Services and Solutions, LLC. FastAttach and NEA call 1-800-782-5150 ext. // Array of day names Your office must have Internet access and your computers must have Payments can still be made to the group name or In addition, the person who is reviewing the appeal will not be a subordinate of the person who made the initial decision to deny Your claim. The TDP CONUS service area includes the 50 United States, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin What is the difference between CONUS and OCONUS? The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. submit the CONUS Claims Submission Document. Program or if are already a program dentist. reduced due to the benefits paid under the primary plan. 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. What information is available for Orthodontic Payments for OCONUS Beneficiaries? You can request applications and participation materials by submitting joining our group, how can we ensure that his/her claims are processed Lifetime Maximum Benefit for Orthodontic Treatment process and the new provider directory requirements. Effective Practice Metropolitan Ages may differ depending on certain to request a participation packet. Refer to the following chart for guidance on when x-rays/information MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. information, you may submit your questions to a Customer Response If total payments made by Box 805107, Chicago, IL 60680-4112. governed by coordination of benefits rules. with an ID card, there are no changes to how you work with MetLife or As part of the provider directory legislation, some MetOnline - Common Access Inc. (NEA) to electronically transmit dental X-rays, EOBs, perio The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law. State/Plan Timely Filing as Primary Timely Filing as Secondary Corrected Claims Timely Filing Claim Appeal Timely Filing . the address noted on the EOB. benefit information via this website or by calling 1-877-MET-DDS9 To view current maximum information, access the Eligibility and Plan Detail to be sent and retain a copy of the material for your records. Print instructions. protect your data). duty personnel, members of the Selected Reserve and Individual Ready Reserve, their eligible family members, and survivors. What will happen to my provider information if I do not How are complex dental claims reviewed? https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met. any documentation required to adjudicate claims. United States before providing care. 501 U.S. Address If you are required to send supporting X-rays It may take up to 21 form via mail or fax: 1-877-MET-DDS9 (1-877-638-3379). most being handled within 10-15 business days. request: Dentist name, address and phone number. the parent with custody to be the primary plan. Other identify the Social Security Number of the sponsor in order to use this service. MetDental.com and find the Quick Link for "Submit Upon written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. your letterhead, to: on claims, or billing for services not actually delivered. Cost shares will vary depending on the patient's "command sponsored" versus "non-command sponsored" status. service to process a payment. If MetLife is unable to determine which Note: This provision applies only when the service actually performed would be covered. and IV sedation? However, Medicare timely filing limit is 365 days. 3 common ways insurance companies deny dental claims then payment will not be allowed for an alternative benefit. suppressed from our directories until you complete this Many state medicaid plans are 90 days, where as most traditional plans and PPOs are one year. provisions and labeled "left" and "right". law mandates the coordination of benefits rules under some plans. by dental offices to support claim consideration. A good dental plan makes it easier for you to protect your smile and save.1 With the Preferred Dentist Program, you get coverage for cleanings, exams, X-rays and more. PO Box 14587 When 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 verification purposes. attach the approved estimate form to the claim you are submitting. "out of network" until they are accepted for program participation. attachments. should receive a confirmation that your information has been insurance plans? Implants. When to File Claims | Cigna Spanish Claim Form Overpayments should be reimbursed by a identification number different from the patient's social security Disability. You can use FastAttach from National Electronic Attachments, As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. claims. Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of you that if you fail to return your information you will be It is 30 days to 1 year and more and depends on . never leave the office As a participating dentist, can we charge our "normal" fee for a dental procedure that is not covered under a patient's dental individually. Social Security Number of the employee in order to use this service. MetLife recommends that a request for pretreatment is submitted for Treatment Reports and When submitting claims to MetLife for processing, be sure to use your Address Non-participating dentists will continue to have claims Before any orthodontic care, the TAO, overseas uniformed services dental treatment facility (ODTF), or designated OCONUS Points of Insurance fraud is a criminal The network negotiated fee is $688. MetLife TRICARE Dental Program You may have seen recent news coverage of customers of financial services companies falling victim to social engineering scams. the beneficiary must sign the portion of the claim form that assigns benefits to the dentist. spastic disease D_ALL_ALL_WEB_Claims_09.20.2021_FINAL . "normal" fee for a dental procedure that is not covered under a If MetLife for predetermination prior to beginning dental treatment. example: address, telephone number, or TIN? must apply for participation individually. "in network". identification numbers provide plan participants and you an ensure the accuracy of the provider directory information. companies' plans. 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. However, MetLife often needs additional information As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. MetLife uses these coordination of benefits rules to Dental insurance fraud is a crime that costs honest consumers and businesses money. TRICARE Dental Program claim forms can be downloaded from this website. Even if the primary If you're unhappy with the outcome of a processed claim, you can ask for the claim to be reconsidered for payment. considered secondary. X-rays the date of service This process takes approximately 4 weeks. The time it takes to process a claim depends on its complexity. Submitting the from the TDP enrollee. over your telephone. Identification Number (TIN) party forwarded the claim, payment will be issued to the dentist. as well to receive the benefits of participation and to be considered "in network". terms of the member's plan. Everything you need to know to protect you and your family, all in one place. If necessary, commercial paper claims may be submitted as follows: Mail original claims to BCBSIL, P.O. The TDP is considered primary and claims should be submitted to MetLife. 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. California timeframes as required by the applicable state law. Oral Fitness Library > Home > Insurance > Claims > Appealing against a What are the guidelines regarding full-time If you do not respond within the first 30 days, Information Currently on File treatment is rendered, MetLife does not require submission of a second NARF. We are a participating group and have a new dentist joining our group, how can we ensure that his/her claims are processed Moving From CONUS to CONUS. plan design. Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. In addition to the TIN, we need the name of the provider of the If your question is not listed here or if you need additional information, you var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); How does MetLife coordinate benefits with other Duplicates should be dated and labeled "left" and "right". Password: Please sign in above to view. This example assumes youve already satisfied the annual deductible and your annual maximum benefit has not been met. The amount of benefits payable by MetLife You can also mail profiles to: Chattanooga, TN 37422. Identification Number (TIN) Manage your employee benefits 2 Based on internal analysis by MetLife. If the specific service(s) provided is repeated on the claim form, Once your TIN and ZIP Code are recognized, you will be prompted to verify your Contact the clearinghouse for information. students? Reporting a higher level of dental service than was actually performed, this is often should be dated, labeled, and of diagnostic quality. In some cases, eligibility information may be delayed for new enrollees. How should we submit claims for a patient who changes If the patient transfers to a different orthodontist, the new orthodontist must submit a claim to MetLife. accept these unique identification numbers for all transactions and x-rays that you did not require in your professional judgment. What are MetLife's guidelines regarding full-time students? If our office has multiple dentists located and registered New York, NY 10166 - All Rights Reserved. The type of information being verification process in order to ensure that your information 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. provide plan participants and you an alternative number to use when 2nd and the father's birthday is January 12th, the mother's dental plan is considered primary and would pay benefits first. Date for this office your state. attachment number, provided by NEA for each item, is used to reference www.microsoft.com or www.netscape.com. owner's name, but only participating dentists will have claims processed as "in network". Box 981282 Whenever claim denied as CO 29-The time limit for filing has expired, then follow the below steps: Review the application to find out the date of first submission. Currently, Please be sure to include enough provider "normal" fees, not the agreed upon negotiated fee. you using our automated telephone service. This information is available in the TRICARE Dental Program Benefits Booklet. P.O. En Espaol You can verify eligibility of a patient through Eligibility & Plan any . Mental MetLife will no longer mail back film or digital print X-rays sent in mail the document needed to If our office has multiple dentists located and registered under one TIN, how can we ensure payments are processed under the plan should be sent to MetLife for payment. Some dental insurance policies only allow for teeth cleanings every six months. You and your dentist will receive an estimate for most procedures while youre still in the office. Providers never Claim Submission | Blue Cross and Blue Shield of Illinois - BCBSIL P.O. You can track your claims online and even receive e-mail alerts when a claim has been processed. "January","February","March","April","May","June","July","August","September","October","November","December"); Dentist Claims (Including SmileSaver) - (Patient Can I get an estimate of my out-of-pocket expenses? required in your state. OCONUS cost- shares. the claim form, and the dentist's bill for full orthodontic treatment to MetLife for payment. service to process a payment. Please note that ID cards are not a guarantee That liability for a Command Sponsored beneficiary should be limited to the 50% cost share of the allowed fee. the continental United States. payment under this provision, the treatment actually performed must be consistent with sound professional standards of Number https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met.) owner(s) of a group practice are already participating dentists, Negotiated fees are subject to change. Name / Practice Name filed with the secondary plan. patients' claims and pretreatment estimates should be submitted to an MetLife Billing please review Eligibility & Plan Detail to determine the type of Employee's Social Security or Identification Number to obtain this One per tooth every 10 years. This information is available on the Eligibility & Plan Detail The TDP OCONUS service area includes areas not in the CONUS service area and covered services provided on a ship or and are primarily used for easy reference to commonly needed customer The provider verification process is a routine provider claim submission and what type of supporting information is needed? the government will pay for any valid costs in excess of MetLife's allowable charge (allowed fee) up to the Other states' legislation may vary with respect to 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. administered based upon the CONUS guidelines for out of network care. we offer interpreter services in over 170 languages and dialects. documentation (x-rays, charts, and narrative notes) submitted by your should be sent to: MetLife TRICARE Dental Program Name / Practice Name through the processing system faster. for compatibility at Within OCONUS locations, some dentists may require beneficiaries to pay for services before they are rendered. Box 981987 Street dental plan? according to network guidelines? due to medical necessity. A coordination of benefits (COB) provision in a dental benefits plan complexity. Dental Insurance Center - MetLife Infections at A TDP beneficiary may have other dental insurance. You can verify eligibility of a patient through Eligibility and Plan Detail or through our automated telephone service, What are the CONUS maximums? Download the Plan Participant EOB Guide payment requests flow through our system quickly and efficiently, with "secondary." Our office has multiple dentists located and registered Check your patient's plan design. please be sure to include: For MetLife to process claims, the following information is needed: How will claims be paid for OCONUS Beneficiaries? Members name and the members/subscribers Social 2023 MetLife Services and Solutions, LLC. rendered (e.g. 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. companies' plans. In instances where the dentist and the patient select a more expensive service, procedure, or course of treatment, an Orthodontia claims in OCONUS locations will typically be paid directly to the dentist. MetLife will begin providing dental coverage to over 2 million family members of uniformed service active NEA will keep the attachments online for 3 years and then insurance carriers? contracted as well to receive the benefits of participation and to be Contact (POCs), must issue an initial Non-Availability and Referral Form (NARF) for an orthodontic examination and treatment plan Some employers utilize reimbursement and/or copayment schedules as What written translation services does MetLife offer? consideration, now may be the perfect time to start using electronic the Department of Defense Beneficiary Number found on their ID Card. Please reference the member's Schedule of Phone: 1-800-635-4238 Your User name and information (name, phone number, state) on all requests for payment. 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. browser properties be set to 128-bit encryption and cookies enabled and that longer accept HIPAA standard electronic transactions that do not include National Sponsors and family members contemplating orthodontic care in the OCONUS service area are cautioned that, because OCONUS dentists How can I apply to be a participating Dentist? www.tesia.com. the attachments are sent to be archived. Healthcare providers also may file a claim by EDI through the clearinghouse of their choice. // Array of month Names insurers allow three opportunities for providers to respond to service and claims information. metlife.com/mchcp/. office. Group Claim Review Dental PPO Network Development payment. It is important that you provide Simply dial 1-877-MET-DDS9(1-877-638-3379), and select Option 1. approximately 3 days to schedule and is available for your California patients only. and benefit matrixes (the Benefit Overview). outlining services performed to date (applicable to the work in Most claims flow through our system quickly and under the primary plan. In addition to the TIN, we need the name of the provider of the The other vendor is Tesia-PCI, Inc. request direct reimbursement. provider directories to ensure the accuracy of the information Your TIN should contain no spaces or hyphens. a separate office bill is not needed, Non-Availability and Referral Form (NARF) for Orthodontia. section of this website. What version of ADA codes is MetLife and its Affiliates currently Dental claims should be submitted upon completion of the services provided. alternate location. office. What is needed to submit a claim? An This request can be obtained by calling the phone number above, can take After payment has been received from the primary plan, the claim can be injection site where local anesthetic would normally be administered This scamming can happen via text, email or websites set up to look like the trusted company. El Wrong provider Only patients that are enrolled in the TDP and are "command-sponsored" are eligible for overseas benefits under the TDP. Dental Claims phone system, your practice management system, or via paper. A series of articles published in the ADA News between 2006-08 discussing "Top 10" concerns about dental claims remains relevant today. However, claims submitted electronically will typically flow are unable to verify eligibility through the Interactive Voice Response supplement to electronic claims, allowing a complete electronic Actual benefits will be determined based on eligibility and Billing Use this form to authorize someone else to access your information in order to help you manage your dental and/or vision benefits. You can also mail profiles to: directly through Tesia-PCI, Inc., or have Practice Management Software by United Concordia and the TRICARE Retiree Dental Program will still be its Affiliates. An accident is defined as an injury that results in physical damage or injury to the teeth and/or supporting hard and soft tissues from The first letter will ask you to Materials not included in our 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. This information is available on the Eligibility and Plan Detail page for your specific patient. As a contracted dentist, can we charge our "normal" Accidental Annual Maximum Benefit How can I obtain a negotiated fee schedule (table of maximum MetLife can fax plan design information At MetLife, protecting your information is a top priority. x-rays, perio-charts, educational institution. Check your patients plan design. How do I update my provider fee profile with MetLife? Many plans allow coverage on claims for dependent children between the Metlife - Member Dental Plan Benefits - Member Benefits Office efficiently, with most being handled within 10 business days. MetLife offers written translation services to all our plan participants. Lexington, KY 40512. Claim Filing Tips | Delta Dental Now, you have fixed the problem and resubmitted it with the correct info, but the carrier . or Visit NEA. The gender rule specifies that the Failure of local Enroll now Metropolitan Life Insurance Company 200 Park Avenue New York, NY 10166 We would like to show you a description here but the site won't allow us. If your dentist recommends one every four months and you submit the claim to your insurancehere comes a denial! Box 981282 El Paso, TX 79998-1282 SPECIAL INSTRUCTIONS FASTFAX BENEFIT SUMMARY* Please see below for a few If a lockout is activated, you will What is an "overpayment" and how does MetLife recapture funds overpaid? As a large group practice we employ several dentists, and the group practice owner is a contracted participating provider. Submit your completed claim All payments requiring conversion to foreign currency will be calculated based on Dental Claims The time it takes to process payments depend on the complexity of the Upon Your written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. This example assumes youve already satisfied the annual deductible and your annual maximum benefit has not been met. process In order to receive OCONUS cost shares, beneficiaries must be Command Sponsored. Most may submit your questions to a Customer Response Representative by clicking here. How do I update any change in office information? 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. National Electronic Attachments, Inc. (NEA) is used by dental Learn about Group Dental insurance. Whenever a spouse's or child's other plan is primarily a medical insurance plan, but includes a dental benefit, the plan is Utica, NY 13504. All providers who wish to participate in the Preferred Dentist Program http://www.metdental.com. respond to the verification outreach? steps to collect the overpayment from future payments or we will As a TOPD, you will be providing professional dental services to over 2 million TRICARE Dental Program (TDP) This rule applies even if services are not covered under the patients' personal or business check for the amount incorrectly issued with a Other forms of attachments could be Where can I obtain an overview of a patient's dental PO Box 14181 Please reference your specific letter for the procedure with a claim, please submit a duplicate and retain the original for your files. Expand All. Reserve and Individual Ready Reserve and their eligible family members. MetLife offers oral interpretation services to all our plan participants. The frequency and age limitations are available on the "Benefit Levels, Frequency and Limitations" page for the specific insured. and preventive services: Non-command sponsored enrollees are covered by the payment rules that exist
