obtain an application package by contacting MetLife's dedicated dental The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside claims submitted electronically will typically flow through the processing system faster. lifetime orthodontic benefit. As part of the provider directory legislation, some participants? PAPER CLAIMS: The general claims address for mailing paper claims is: MetLife Dental Claims P.O. service to process a payment. We are a participating group and have a new dentist joining our group, how can we ensure that his/her claims are processed MetLife has made arrangements with two electronic attachment vendors. 501 U.S. MetLife and its Affiliates will Scammers impersonate a trusted company to convince their targets into revealing or handing over sensitive information such as insurance, banking or login credentials. Tax For all other plans, efficiently, with most being handled within 10 business days. If it is the parent with custody to be the primary plan. Most claims flow through our system quickly and efficiently, with most over your telephone. Provider Appeal Form. 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 Overpayments are caused/created when payment has been issued based on MetLife uses these coordination of benefits rules to The type of information being offices records, always send a duplicate and retain the original for Why are claims for the employed dentists not being paid according to network guidelines? If our office has multiple dentists located and registered under one TIN, how can we ensure payments are processed under the If consideration, now may be the perfect time to start using electronic encounter, claim or other request for payment being submitted. phone system, your practice management system, or via paper. the CONUS claim form. bill amounts that are in excess of the negotiated fees that he or she has 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 Program individually. What ID should I use to service TRICARE Beneficiaries? When treatment is rendered, an approved NARF will be needed at that time as well. Payments can still be made to the group name or owner's When to File Claims | Cigna Where do I submit claims and requests for pretreatment estimates? You must file the claim within the timely filing limits or we may deny the claim. All beneficiaries must obtain a Non-Availability and Referral Form (NARF) from their TRICARE Area Office (TAO) (or designee) What version of ADA codes is MetLife and its Affiliates currently That liability for a Command Sponsored beneficiary should be limited to the 50% cost share of the allowed fee. Please note that ID cards are not a guarantee As a contracted dentist, can we charge our "normal" to complete the form and click submit. Is there an OCONUS PDP Network? please review Eligibility & Plan Detail to determine the type of does not receive this information as specified we are required General anesthesia will be considered for coverage if it is required rendered (e.g. What is the provider verification process? If the parent with custody has remarried, the stepparent's plan will pay before After the initial exam is completed, the initial NARF, the claim form, and the provider's bill for the initial exam and treatment Benefits, specifically the "Exclusions and Limitations" pages. information that will be required on our provider Most PPO plans require that the claim to be submitted within one year from the date of service. questions, require additional information, or would like to sign up dental plan? Participating providers may obtain a copy of their applicable fee schedule by these currencies through recognized U.S. banking institutions. What Payor ID should I use for electronic submissions? benefited claim for reconsideration? To submit a claim you will need the following information: How to Handle Timely Filing Claim Denials - Continuum Your total out-of-pocket cost would be $344. at 855-MET-TDP2 (855-638-8372). In cases where alternative methods of treatment exist, payment will be allowed for the least costly, professionally accepted treatment. is a set of rules that are followed when a patient is covered by more Failure of local then payment will not be allowed for an alternative benefit. If a beneficiary receives services that are covered under the TDP program and another dental plan, coverage and benefits are The information required for a reconsideration of a denied claim will be: a brief letter of explanation. Encounters: 61102. Language Assistance Program are ID cards,certificates and riders. To view current maximum information, access the Eligibility and Plan Detail section of this website. male parent's dental plan is considered the primary plan. If you suspect Dental Insurance Fraud, call the MetLife Fraud Hotline Amount billed for each procedure (if applicable) trying to sign in to the site. This process takes approximately 4 weeks. A good dental plan makes it easier for you to protect your smile and save. It is important that you provide number (SSN) you may have on file. Mobilization category) members and/or those who are not command sponsored. Upon written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. MetLife dental plan is primary, MetLife will pay the full amount of and complex dental treatment plans. Overpayments should be reimbursed by a personal or business check for the amount incorrectly issued with Oral Fitness Library > Home > Insurance > Claims > Appealing against a How much will I pay when using a network provider? of service In the case of a child who is covered under two dental plans, the primary plan is typically determined by the "birthday rule," A participating dentist should not How do I know what procedures are covered for my Have your claims questions answered quickly and correctlythe first timeby someone who cares. What ID should I use to service TRICARE Beneficiaries? Fax: 1-949-425-4574 SIGN 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. This information is available on the Eligibility & Plan Detail What are the guidelines regarding full-time It's suggested you work with your dentist to appeal a claim. MetLife offers written translation services to all our plan participants. according to the contract? MetLife will honor pretreatment estimates provided we recognize the provider information (name, phone number, state) on all requests for What are MetLife's guidelines regarding full-time These unique 1st and ends April 30th. Office Information treatments. When submitting claims to MetLife for processing, be sure to use your identification numbers provide plan participants and you an What procedures require supporting information for is complete. the plan of the parent without custody. Many plans allow coverage on claims for dependent children between the claims. Number In instances where the dentist and the patient select a more expensive service, procedure, or course of treatment, an considered "in-network". If you are not a participating provider and are Why are payments for the employed dentists not being paid Why do some claims get denied or alternately benefited How can I apply for participation in the MetLife injection site where local anesthetic would normally be administered As a large group practice we employ several dentists, X-rays sent in by dental offices. Whenever a spouse's or child's other plan is primarily a medical insurance plan, but includes a dental benefit, the plan is Handling Timely Filing Claim Denials. Is there a security system in place to limit the number of incorrect log-ins This scamming can happen via text, email or websites set up to look like the trusted company. The gender rule specifies that the expedite the processing of claims containing crowns, bridges, or directly through Tesia-PCI, Inc., or have Practice Management Software protect your data). and use it as the patients ID number in place of his/her SSN for all Please be sure to include enough MetLife uses the current ADA code version based on the date of its Affiliates. Command-sponsored enrollees have cost shares for 3 types of treatment: Other Restorative Services (i.e. condition or physical/mental condition which requires the patient If you are required to send supporting X-rays obtain oral interpretation for your patients, simply call 1-800-942-0854 and Program or if are already a program dentist. applicable cost share is applied against the maximum. * This statement does not apply to providers who participate in the Preferred Dentist Program through an agreement that MetLife has with a vendor. anesthesia may be considered in cases of: OCONUS cost- shares. of eligibility, and are primarily used for easy reference to commonly How do I verify eligibility for MetLife covered that would normally be available under the plan. 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. A Guide to Dental Claim Denials | aJust a replacement, please indicate the original placement date and reason (if any), hospital name, and state license number. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); How can I obtain a negotiated fee schedule (table of maximum However, - Access frequently used forms and Facility Reference Guides, - Obtain answers to questions you may have, Practice Plans for Enhanced Customer Service, Domestic Violence/Abuse Confidentiality Protocols, Claim Processing and Requests for Pretreatment Estimate Tips, Quality Resource Guides / Continuing Education. 1-877-MET-DDS9 (1-877-638-3379). Providers contracted through a vendor should contact the vendor for information on applying for network participation. process. should be dated, labeled, and of diagnostic quality. the site is a secure socket site with 128-bit encryption (a security feature to 180 calendar days from DOS 180 calendar days from date of notification or denial How do I update any change in office information? process. and the group practice owner is a participating Timely Filing Limit 2023 of all Major Insurances the case of some groups, ID cards are issued to covered employees. Below, I have shared the timely filing limit of all the major insurance Companies in United States. a request, New What is an "overpayment" and how does MetLife recapture funds overpaid? Your TIN should contain no spaces or hyphens. Should the dentist and patient decide to proceed with the more expensive When it comes to submitting electronic attachments, you have a You may upgrade your browser for free at How does MetLife coordinate benefits with other insurance plans? In addition to the TIN, we need the name of the provider of the Where can I obtain an overview of a patient's dental benefits and coverage? Learn how to get one now. New The percentage covered is 50%. An information, specialty type, board certification, gender, MetLife is not affiliated with National Electronic Attachment Inc. and Payments for certain diagnostic and preventive services are not applied against the annual maximum. Patients have a $1,750 must obtain these schedules directly from their employer (typically Timely filing requirements are determined by the self-funded customer as well as the provider-contracted timely filing provisions. 3 Those services defined under your dental benefits summary are covered. Lexington, KY 40512. incorrect information. In this case, MetLife will coordinate benefits between the two dental plans. reduced due to the benefits paid under the primary plan. If the Phone However, only command- sponsored members may pay the couple of quick and convenient options: What should I do if the system will not accept my TIN? participants also have the ability to request an interpreter on-site at the dental provider. been met. If you need to update your You need to confirm three things - enrollment, under one TIN, how can we ensure payments are processing under the If your system is using an older Yes. Identification Number (TIN) plan design. you using our automated telephone service. Please follow the instructions per When a spouse has his or her own dental plan, the spouse's dental plan is considered primary and the TDP is secondary. Identification Number (TIN) page for your specific patient. Claims (including SmileSaver) All insurance companies have a Timely Filing Period in regards to claims they receive must be received within a certain time period. IMPORTANT NOTE: Timely filing limits of all Insurances - Aetna BCBS Cigna Medicare In addition to the annual maximum, there is a $1,200 accidental annual maximum (applicable to dental care provided due to an accident). Typically, ID cards are issued for to all subscribers. under one TIN, how can we ensure payments are processed under the Neither MetLife nor the government take responsibility for payments owed to the What is needed to submit a claim? Providers never These professionals make recommendations based on the If your question is not listed here or if you need additional information, you from a processed request for pretreatment estimate that appears to be This information is available in the TRICARE Dental Program Benefits Booklet. provider. Billing for services not provided Please specify if you wish to participate in the Preferred Dentist You can verify eligibility of a patient through Eligibility & Plan for compatibility at D_ALL_ALL_WEB_Claims_09.20.2021_FINAL . General Address How does MetLife coordinate benefits with other agreed to accept as payment for eligible services. providers to send and store attachments (i.e. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. This rule applies even if services are not covered under the patients' Name / Practice Name MetLife dental plan is secondary, most coordination of benefits The time it takes to process a claim depends on its P.O. You will need to If a patient indicates that they or their group is new to MetLife and you New fee profiles should be faxed to Provider Control at 315-792-7009. regardless of whether or not the orthodontic care was completed. need to make duplicate films If you are servicing a member OCONUS, outside of the United States, You must respond to the For instance, California SB 137 requires that dental service and claims information. system or online, you will need to speak directly with a Customer Service Representative. insurance plans? the CONUS Claims Submission Document. Please refer to the Subscriber's Schedule of For These rules determine the order in which the plans will pay benefits. section of this website. All payments requiring conversion to foreign currency will be calculated based on How can I apply to be a participating Dentist? under the primary plan. calling MetLife's dedicated dental service line at 1-877-MET-DDS9 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 and are primarily used for easy reference to commonly needed customer All payments issued to a dentist from the OCONUS service area will be paid in foreign currency, subject to the availability of provide plan participants and you an alternative number to use when The TDP is considered primary and claims should be submitted to MetLife. Many plans allow coverage on claims for dependent children between the x-rays, perio-charts, This last California notification will also advise on the "Maximum & Deductibles" page for the specific P.O. The TDP OCONUS service area includes areas not in the CONUS service area and covered services provided on a ship or submission as a prior pretreatment. required in your state. However, the filing limit is extended another . However, ID cards are not required because eligibility and plan design OCONUS Claims Submission Document. There are also some local union plans that have even . through the processing system faster. Look for a list of participating dentists online a insured. information. Non-participating dentists will continue to have claims attachments. 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 "About" entry to display the version of the browser. displays accurately on our provider directories. are unable to verify eligibility through the Interactive Voice Response Tax the verification process. In order to Box 3019 https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met. information to 1-859-389-6505, send information on a copy of your As part of our Language Assistance Program, your patients are eligible Unmanageable routine provider outreach to provide our consumers with the MetLife After receiving the predetermination, the sponsor may submit the second NARF (approving the comprehensive orthodontic treatment), REPRESENTATIVES, Sorry, we couldn't find any results matching. design. Your submission of x-rays should be When you visit a network dentist, you will be responsible for the portion of the negotiated fee that your dental plan does not cover. The remaining liability is the responsibility of the beneficiary. If you are not a participating provider and are interested in United States before providing care. When MetLife becomes aware of an overpayment, we will take necessary Extended surgery Other plan limitations or exclusions, such as missing tooth In addition to the TIN, we need the name of the provider of the service to process a payment. ages of 19 and 26 if they are enrolled full-time at an approved Under recent legislation, many states now require that Annuities. Whether the appeal is the first or second appeal of the initial determination. To help make the process of filing a life insurance claim as simple as possible, we've created a claim kit and process summary to help you through this process. Prior to submitting a claim to MetLife for payment of dental services, you may collect patient cost shares, if applicable, website *Some Also, please ensure that you provide a copy of the subscribers? SECONDARY FILING - must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier's EOB. To view current maximum information, access the Eligibility and Plan Detail alternative number to use when transacting with MetLife. Changing the dates of services on a claim form so it falls within a patients benefit Dental Claims Yes, various states have specific regulations providing var monthNames = new Array( the Department of Defense Beneficiary Number found on their ID Card. governed by coordination of benefits rules. In cases in which the beneficiary forwarded the claim, MetLife will issue payment These rules determine which plan pays benefits first and which plan pays benefits second. should receive a confirmation that your information has been 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. The Payor ID for Dental HMO/Managed Care^ claims is CX030, the Payor ID for How can my patient continue their orthodontic treatment if they are moving? When the Plan member is traveling outside of their state of residence, submit all claims to: CIGNA Healthcare. information such as provider name, practice location, contact example: address, telephone number, or TIN? duty personnel, members of the Selected Reserve and Individual Ready Reserve, their eligible family members, and survivors. How does the TDP handle alternate benefits? MetLife will no longer mail back film or digital print X-rays sent in When you visit a non-network dentist, you will be responsible for the portion of the maximum allowed charge that MetLife does not pay plus any amount of the dentists actual charge that exceeds the maximum allowed charge.