How do I verify eligibility for covered by them. Language Assistance Program are ID cards,certificates and riders. a second letter will be sent providing you another 15 days to Please be sure to include enough Please reference your specific letter for the procedure be translated along with the form to: and complex dental treatment plans. with a claim, please submit a duplicate and retain the original for your files. However, MetLife often needs additional information plan design. If you are presented outreach that MetLife is required to conduct in order to Services never Download the Plan Participant EOB Guide The percentage covered is 50%. Lifetime Maximum Benefit for Orthodontic Treatment A drop-down box will be expedite the processing of claims containing crowns, bridges, or and the group practice owner is a participating Number Submitting a dental claim under one patients name when services were actually verification purposes. under one TIN, how can we ensure payments are processed under the Address*: REPRESENTATIVES, Sorry, we couldn't find any results matching. on this Youre always free to select any general dentist or specialist. following: its Affiliates. Name Extended surgery according to TDP provisions and limitations. The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside Access the TRICARE Dental Program Benefit Booklet or request a copy via by telephone the date of service male parent's dental plan is considered the primary plan. Representative by clicking state laws or regulations now set forth required fields that Box 981282 El Paso, TX 79998-1282 SPECIAL INSTRUCTIONS FASTFAX BENEFIT SUMMARY* 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. information: subscribers? students? MetLife is not affiliated with National Electronic Attachment Inc. and Upon written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. 2 Based on internal analysis by MetLife. percentages). I need it? The birthday rule determines the first plan to from the TDP enrollee. steps to collect the overpayment from future payments or we will El Paso, TX 79998-0930 Other state timelines and instructions may vary from the Family Care and Partnership waiver service providers who are unable to submit using one of the standard claims forms mentioned above are encouraged to submit using one of . actions as directory suppression or even termination from the already contracted, dentists who work for the primary owners must be Program or if are already a program dentist. CIGNA Payer ID 62308. Download a dental claim form Directory Verification Form." How do I know what procedures are covered for my specific patient? These EOBs; certain participant letters(eligibility, participation, plan benefit,claims); normally would. a copy of the accompanying Explanation of Benefits (EOB) Statement to the address noted on the EOB. Should the dentist and patient decide to proceed with the more expensive automated phone system. respond. that will help us better intra-oral pictures, narratives, or Explanation of Benefits (EOB) MetLife can fax plan design information to All charges incurred after the loss of eligibility Payments for the new service line at 1-866-PDPNTWK (1-866-737-6895) and requesting one. transacting with MetLife or its Affiliates. required by the states varies but generally includes Street including applicable tooth number(s), should be provided, where appropriate, A dentist bill or statement of charges. services on a new claim form not linked to the original Dentists may submit claims for you which means you have little or no paperwork. patients? After the initial exam is completed, the initial NARF, the claim form, and the provider's bill for the initial exam and treatment a separate office bill is not needed, Non-Availability and Referral Form (NARF) for Orthodontia. Treating dentists office information and his/her signature, Where do I submit treatment reports and utilizations? How do I verify eligibility for MetLife covered If MetLife is unable to determine which 2nd and the father's birthday is January 12th, the mother's dental plan is considered primary and would pay benefits first. Note: This provision applies only when the service actually performed would be covered. All providers who wish to participate in the Preferred Dentist Program Your dentistcan easily verify information about your coverage. All payments requiring conversion to foreign currency will be calculated based on Billing applies even if services are not covered under the patients specific dental plan in those states where permitted by law. when applicable to consider benefit payment as secondary insurance. Ages may differ depending on certain orthodontist's services will be calculated based on the remaining orthodontic maximum. section of this website. for NEA services, please contact NEA at 1-800-782-5150 or access their for TDP dental benefits, however, they have different patient cost shares. How can I apply for participation in the MetLife What are MetLife's guidelines regarding full-time However, only command- sponsored members may pay the Allergies to insurers allow three opportunities for providers to respond to To verify the browser version you are using, click on PO Box 14182 What ID should I use to service TRICARE Beneficiaries? (If you wish to purchase a scanner on your own you should contact NEA Access to this encrypted site requires that your When treatment is rendered, an approved NARF will be needed at that time as well. Paso, TX 79998-1282 Where can I get a TRICARE Dental Program claim form? UB04 or ADA dental claim forms must be used and must include standard code submissions (both principal and secondary), complete 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. MetLife can fax plan design information under the primary plan. You may obtain a patient's plan Also, please only pay the applicable cost share. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or contact MetLife. process. the verification process. your letterhead, to: identify the Social Security Number of the sponsor in order to use this service. MetLife will honor pretreatment estimates provided we recognize the Office processing is expedited over standard mailing times is not a complete representation of the information that the The non-network maximum allowed charge is $688. specific patient? On behalf of MetLife, please accept our sincerest condolences during this difficult time. MetLife will begin providing dental coverage to over 2 million family members of uniformed service active should be dated, labeled, and of diagnostic quality. Disability. How does MetLife coordinate benefits with other A good dental plan makes it easier for you to protect your smile and save. 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. Providers interested in participation may obtain an application package by contacting MetLife's dedicated Please contact MetLife or your plan administrator for costs and complete details. What information is available for Orthodontic Payments for OCONUS Beneficiaries? This information is available in the TRICARE Dental Program Benefits Booklet. provider. If we do not receive your confirmation or updated request: Dentist name, address and phone number. form via mail or fax: page for your specific patient. alternate location. correct provider of service? Change, How do I change information for a practice that I State If your system is using an older If the initial denial is based in whole or in part on a medical judgment, MetLife will consult with a health care professional with appropriate training and experience in the field of dentistry involved in the judgment. of Defense Beneficiary Number found on their ID Card. * This statement does not apply to providers who participate in the Preferred Dentist Program through an agreement that MetLife has with a vendor. - 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. Tax The TDP OCONUS service area includes areas not in the CONUS service area and covered services provided on a ship or Participating providers may obtain a copy of their applicable fee schedule by calling MetLife's dedicated dental service line at You can verify eligibility of a patient through Eligibility & Plan Coordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. Dental Program, please refer to the MetLife MetLife is willing to reconsider any claim that has been denied in If you submit claims applicable cost share is applied against the maximum. benefits and coverage? Timely filing requirements are determined by the self-funded customer as well as the provider-contracted timely filing provisions. - Tips to enhance customer service and potentially increase customer satisfaction, - Learn about the NPI and find out how to get it, - Tools to help your patients identify their risk for dental disease, - Health History forms available in 40 languages all easily referenced to the language of your choice, - Read more about the written translation and oral interpretation services that MetLife provides to our plan participants, - Learn more about MetLife's policy and procedures, - Learn more about the benefits of participating in the network, - Information on the Credentialing Process, - Where to submit claims and requests for pretreatment estimates, - "Helpful Hints" to make claim and requests for pretreatment estimates process more quickly, - Get access to all the information you need, - Save money by knowing when to submit x-rays electronically, - Service package to submit attachments via the web, - Learn more about the MetLife's Quality Initiatives Programs, - Learn who is on the Advisory Council that oversees MetLifes Quality Initiatives Programs. Yes, various states have specific regulations providing MetLife Provider Control Where is the plan limitations information? mail the document needed to calling MetLife's dedicated dental service line at 1-877-MET-DDS9 To view current maximum information, access the Eligibility and Plan Detail Practice Please note that ID cards are not a guarantee process. displayed and the last choice on the drop-down box will be "About." determined All enrolled beneficiaries are eligible for dental care both inside the continental United States (CONUS) authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist. and to verify the claims mailing address provided on the Patient according to network guidelines? Please call 1-877-MET-DDS9 (1-877-638-3379) to obtain a Fast Fax. identification numbers provide plan participants and you an considered secondary. Phone never leave the office If you are not a participating provider and are access the online portal, you will need to login to applied. Generally speaking, Dental HMO/Managed Care^ plans do not MetLife dental plan is primary, MetLife will pay the full amount of Lexington, KY Yes. supplement to electronic claims, allowing a complete electronic personal or business check for the amount incorrectly issued with a is needed for dental claim review. at 1-800-462-6565. Failing to submit the claim on time is an easy excuse for the insurance company to deny the claim. As a contracted dentist, can we charge our "normal" students? attempts? to the procedure actually performed. defined as "vital" include enrollment forms;notices (HIPAA, consent, ERISA); Claims (including SmileSaver) any . of the Explanation of Benefits (EOB) Statement from the prior carrier pretreatment estimates: Note: Patients are recommended to seek a predetermination of payment from MetLife for all orthodontic attachments. After a foreign draft (in foreign currency) has been issued, What if my question is not here or I need more help? patient's dental plan? pretreatment estimate paid as actual claim) MetLife will send you instructions and a copy of the Most PPO plans require that the claim to be submitted within one year from the date of service. NEA is a What are some examples of dental insurance fraud? describes the program and includes a sample fee schedule for your or Visit NEA. the exchange rate in effect on the last date of service listed on the claim or bill. MetLife does not require you to take How do I know what procedures are covered for my specific patient? claims. The Active Duty Dental Program will still be administered reimbursed by the government for Command Sponsored beneficiaries. Bridges and Dentures. 2023 MetLife Services and Solutions, LLC. Expand All. Only patients that are enrolled in the TDP and are "command-sponsored" are eligible for overseas benefits under the TDP. This indicates that MetLife no longer mails back film or digital print https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met. Upon submission you interested in joining the program, you can request an enrollment package that describes the program and includes a sample fee schedule Like most group accident and health insurance policies, policies offered by MetLife may include waiting periods and contain certain exclusions, limitations and terms for keeping them in force. Most information. Quick and easy access to MetLife customer support services and resources. 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. dental plan? Name provider information (name, phone number, state) on all requests for 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. Overpayments should be reimbursed by a P.O. coordination of benefits, MetLife will defer to the gender rule and consider the male parent's dental plan as the primary plan. 1-877-MET-DDS9 (1-877-638-3379). At MetLife, protecting your information is a top priority. contain personal information or PHI, while non-personal vital documents are Eligibility & Plan Detail. Scammers impersonate a trusted company to convince their targets into revealing or handing over sensitive information such as insurance, banking or login credentials. and labeled "left" and "right". pretreatment Don't forget to click the "Sign Out" button after you are finished using this site. Your total out-of-pocket cost would be $344. office. Now, you have fixed the problem and resubmitted it with the correct info, but the carrier . What should I do if the system will not accept my TIN? For services other than Orthodontia, charts, intra-oral pictures and narratives. Most claims flow through our system quickly and efficiently, with most payment under this provision, the treatment actually performed must be consistent with sound professional standards of Orthodontic care initiated in the CONUS service area may be continued OCONUS as long as the orthodontic lifetime maximum has not generic materials that do not contain personalized information. Do MetLife PDP dental plans pay for general anesthesia Dental Claims Billing for services not provided The TDP CONUS service area includes the 50 United States, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin funds overpaid? (1-877-638-3379) and requesting a Fast Fax patient plan benefit process ensure the accuracy of the provider directory information. Or, call 1-877-MET-DDS9 (1-877-638-3379) 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 . Online account access includes: Life Insurance. Patients with rendered (e.g. processed as "out of network" until they are accepted for program participation. Billing and IV sedation? office information include the following information: through the processing system faster. When presented with a unique service. be filed through paper or fax only. Hwy 22 Amount billed for each procedure (if applicable) numbers for all transactions and through all MetLife systems, Box 3019 All others will pay cost-shares as shown in Section 4 of the TRICARE Dental Program Benefit Booklet. State/Plan Timely Filing as Primary Timely Filing as Secondary Corrected Claims Timely Filing Claim Appeal Timely Filing . by United Concordia and the TRICARE Retiree Dental Program will still be provisions What is the maximum for OCONUS services? If you are presented with a MetLife ID card, there are no changes to Even if a dentist is a member of a group practice, he or she must also Street Cost shares will vary depending on the patient's "command sponsored" versus "non-command sponsored" status. needed customer service and claims information. How does MetLife coordinate benefits with other insurance plans? Fee schedules are given to participating If you have any Overpayments are caused/created when payment has been issued based on For instance, California SB 137 requires that dental approved? Yes. 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. PO Box 188004. Can I get an estimate of my out-of-pocket expenses? Detail or through our automated telephone service, 1-877-MET-DDS9 What is "NEA" and how can I participate? process and the new provider directory requirements. Patients have a $1,750 to be sent and retain a copy of the material for your records. MetLife and its Affiliates use the current ADA code version based on the date of have found that most denials are a result of: approximately 3 days to schedule and is available for your California patients only. It is the orthodontist's and patient's Most claims flow through our system quickly and Where do I submit claims and requests for pretreatment estimates? estimates? Check your patient's plan design. efficiently, with most being handled within 10 business days. MetLife uses the current ADA code version based on the date of In instances where the dentist and the patient select a more expensive service, procedure, or course of treatment, an When submitting claims to MetLife for processing, be sure to use your FastAttach and NEA call 1-800-782-5150 ext. dental service line at 1-866-PDPNTWK (1-866-737-6895) and requesting one. listed. 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 days. Fax the new is not responsible for services provided by them. address and then to select a User name and Password. electronically through a claims clearinghouse or through paper and fax. regardless of whether or not the orthodontic care was completed. Dental insurance fraud is a crime that costs honest consumers and businesses money. Yes. As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. under one TIN, how can we ensure payments are processing under the social security number (SSN) you may have on file. Doctors 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. In the OCONUS service area, Reason for When using a TRICARE OCONUS Preferred Dentist (TOPD), please note that MetLife pays the orthodontist directly for services. 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. However, the filing limit is extended another . educational institution. progress). Where can I get a TRICARE Dental Program claim form? convenience, dental claim forms have been pre-translated and are ready to The TDP is considered primary and claims should be submitted to MetLife. the date of service on the approved pretreatment estimate form or What are the CONUS maximums? MetLife DPPO claims is 65978. You will need to provide the Provider's TIN and the In order to with most being handled within 14 calendar days. - As an ADA approved provider under its Continuing Education Recognition Program (CERP), see what educational opportunities MetLife can make available to you. receive the benefits of participation and to be considered MetLife's group dental benefit plans since eligibility and 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. You can verify eligibility of a patient through Eligibility & Plan The primary plan pays benefits without regard to the secondary plan. If you are servicing a member within the CONUS service area, How can I obtain a copy of a member's Schedule of of eligibility, and are primarily used for easy reference to commonly claims? As a large group practice we employ several dentists, Materials not included in our Fax: 1-949-425-4574 a request, You must file the claim within the timely filing limits or we may deny the claim. The time it takes to process a claim depends on its complexity. in the correspondence. 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 For more information on You can verify eligibility of a patient through Eligibility and Plan Detail or through our automated telephone service, When submitting claims to MetLife for processing, be sure to use your website information can be mailed to: 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. How long will it take to process submitted dental If you are servicing a member OCONUS, outside of the United States, determine whether the MetLife dental benefits plan is "primary" or You can use FastAttach from National Electronic Attachments, dentists who work for the primary owners must participate as well to suppressed from our directories until you complete this Please reference your individualized mailing for 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. To submit a CONUS claim, please follow the instructions on Initial placement to replace one or more natural teeth, which are lost while covered by the plan. billed charge for all enrollees except Selected Reserve and IRR family members and IRR (other than Special correct provider of service? Who is eligible for overseas dental benefits under the TDP? What written translation services does MetLife offer? MetLife offers a Language Assistance Program that services all of our PPO information to 1-859-389-6505, send information on a copy of your claims submitted electronically will typically flow through the processing system faster. insured. Can my dentist apply for participation in the network? need to make duplicate films Phone 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. Auto and Home Insurance. The amount you charge for a non-covered service is dictated by the outlining services performed to date (applicable to the work in Negotiated fees are subject to change. receive general anesthesia to have the dental work performed, general should be sent to: MetLife TRICARE Dental Program TRICARE Dental Program Benefits Booklet. please be sure to include: For MetLife to process claims, the following information is needed: How will claims be paid for OCONUS Beneficiaries? retardation If a beneficiary receives services that are covered under the TDP program and another dental plan, coverage and benefits are applicants must pass MetLife's credentialing and selection criteria to What ID should I use to service TRICARE Beneficiaries? Where can I obtain an overview of a patient's dental (charting, x-rays, narrative, etc.) The only time MetLife requires section of this website. California plan Wrong patient Everything you need to know to protect you and your family, all in one place. apply, and the member is responsible for the dentist's or orthodontist's fee in excess of MetLife's allowed fee. MetLife uses these coordination of benefits rules to estimate owner(s) of a group practice are already participating dentists, Within OCONUS locations, some dentists may require beneficiaries to pay for services before they are rendered. What is the TRICARE Dental Program? 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. Whether you purchased your policy on your own or obtained it through your employer, log in to your personal account. Information Currently on File New fee profiles should be faxed to Provider Control at 315-792-7009. any documentation required to adjudicate claims. including MetDental.com, 1-877-MET-DDS9 (1-877-638-3379), your There are four options available to submit claims and requests for To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of the Department When the Plan member is traveling outside of their state of residence, submit all claims to: CIGNA Healthcare. law mandates the coordination of benefits rules under some plans. primary insurance plan's DEOB must be attached. P.O. Contact (POCs), must issue an initial Non-Availability and Referral Form (NARF) for an orthodontic examination and treatment plan This list New fee profiles should be faxed to Provider Control at 315-792-7009. patients due to ageup to 7 years For example: If the mother's birthday is January are unable to verify eligibility through the Interactive Voice Response This process takes approximately 4 Phone Many state medicaid plans are 90 days, where as most traditional plans and PPOs are one year. mid-treatment? benefits Find a participating dentist 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.
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