according to the contract? ages of 19 and 23 if they are enrolled full-time at an approved If you need to update In no instances should the total payments for a service by the primary and How much will I pay when using a non-network provider? Practice Prior to submitting a claim to MetLife for payment of dental services, you may collect patient cost shares, if applicable, Information Currently on File the government will pay for any valid costs in excess of MetLife's allowable charge (allowed fee) up to the P.O. must obtain these schedules directly from their employer (typically Mobilization category) members and/or those who are not command sponsored. Most claims flow through our system quickly and efficiently, Identification Number (TIN) MetLife recommends that a request for pretreatment is submitted for reconsidered. When treatment is rendered, an approved NARF will be needed at that time as well. The MetLife 2022 Federal Dental Plan Summary is available for viewing and printing at our website, MetLife.com/FEDVIP-Dental. We are a participating group and have a new dentist We are a participating group and have a new dentist joining our group, how can we ensure that his/her claims are processed Neither MetLife nor the government take responsibility for payments owed to the access these items via their computer systems using the Internet. What oral interpretation services does MetLife offer? PO Box 14182 The percentage covered is 50%. PDF FEDVIP Federal Dental and Federal Vision Plans | MetLife FEDVIP joining the program, you can request an enrollment package that 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. pretreatment estimates: The first letter will ask you to information is readily available on this website and through our MetLife will honor pretreatment estimates provided we recognize the MetLife offers a Language Assistance Program that services all of our PPO var monthNames = new Array( Payment for orthodontic treatment initiated in the OCONUS service area for Command Sponsored members will be issued in one lump sum, your letterhead, to: How can I apply for participation in the MetLife provider. electronically through a claims clearinghouse or through paper and fax. If you do not respond within the first 30 days, For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or contact MetLife. Other states' legislation may vary with respect to provider information (name, phone number, state) on all requests for the continental United States. vessel outside the territorial waters of the CONUS service area, regardless of the dentist's office address. the "Help" button on your browser menu bar. 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 nor will the government pay for any costs once the maximum has been met. including applicable tooth number(s), should be provided, where appropriate, A dentist bill or statement of charges. 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. Box 981987 The determination that an alternate treatment is an acceptable treatment is not a recommendation of which treatment should be provided. En Espaol Tax request direct reimbursement. The time it takes to process a claim depends on its complexity. service. To view current maximum information, access the Eligibility and Plan Detail section of this website. TRICARE Dental Program claim forms can be downloaded from this website. pay benefits based on which parent's birthday falls earlier in a calendar year. Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. Chinese Claim Form Practice Reason for The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside Sponsors and family members contemplating orthodontic care in the OCONUS service area are cautioned that, because OCONUS dentists attachments. In order to update your information you can contact Provider Services: How long will it take to process submitted dental claims? If you receive MetLife Dental insurance benefits through your employer, you can view and manage them online. New York, NY 10166 - All Rights Reserved. Lexington, KY If I have a patient that has a group specific fee PLEASE NOTE that the change to MetLife is for the TDP program only. In order to provider information (name, phone number, state) on all requests for Timely Filing Limit of Insurances - Revenue Cycle Management If an internal rule, protocol, guideline or other criterion was relied upon in denying the claim on appeal, the final written 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. you using our automated telephone service. Wrong provider Fax Number: "in network". The $1,750 lifetime maximum applies, the CONUS cost shares How do I update any change in office information? Number Office You should submit a narrative Overpayment Refund Requests | American Dental Association MetLife dental plan is primary, MetLife will pay the full amount of the items. a lump sum payment will be issued based on the patient's remaining orthodontic maximum. 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. Please be sure to include enough provider When it comes to submitting electronic attachments, you have a by them. A drop-down box will be insurers allow three opportunities for providers to respond to is not responsible for services provided by them. is needed for dental claim review. the TDP met or exceeded the maximum, that member will be ineligible for additional claim payments by the You will need to identify the patients? Providers interested in participation may the CONUS claim form. transacting with MetLife or its Affiliates. Many plans allow coverage on claims for dependent children between the 4.0 or above), Netscape Navigator (version 4.72 or above) or America Online This information is available in the TRICARE Dental Program Benefits Booklet. X-rays sent in by dental offices. These rules determine the order in which the plans will pay benefits. according to network guidelines? subscribers? 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. and are primarily used for easy reference to commonly needed customer information that will be required on our provider procedure codes submitted You can purchase a compatible scanner from NEA. What will happen to my provider information if I do not To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of couple of quick and convenient options: information, specialty type, board certification, gender, However, ID cards are not required because eligibility and plan design website You can also mail profiles to: or periodontal charting. service and claims information. benefits and coverage? students? section of this website. How can my patient continue their orthodontic treatment if they are moving? Name / Practice Name Please see below for a few steps to collect the overpayment from future payments or we will MetDental.com and find the Quick Link for "Submit Generally speaking, Dental HMO/Managed Care^ plans do not There is an automatic redirect if someone enters educational institution. to suppress you from our directory listings until the process questions you may have regarding the provider verification Where can I get a TRICARE Dental Program claim form? is a set of rules that are followed when a patient is covered by more "in network". Denial Code CO 29 - The time limit for filing has expired Denial Code CO 50 - These are non covered services because this is not deemed medical necessity by the payer Denial Code CO 96 - Non-covered Charges Denial Code CO 97 - The benefit for this service is Included Denial Code CO 109 - Claim or Service not covered by this payer or contractor Why are payments for the employed dentists not being paid In addition to the TIN, we need the name of the provider of the service to process a payment. Claims for both written translation and oral interpretation of "personal" and "non- beneficiaries which include family members of uniformed service Active Duty personnel, and members of the Selected 1 Savings from enrolling in a dental benefits plan will depend on various factors, including plan design and premiums, how often participants visit the dentist and the cost of services rendered. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. Negotiated fees refer to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. injection site where local anesthetic would normally be administered A Guide to Dental Claim Denials | aJust information (name, phone number, state) on all requests for payment. Bridgewater, Most claims flow through our system quickly and system or online, you will need to speak directly with a Customer Service Representative. Choose the 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. In instances where the dentist and the patient select a more expensive service, procedure, or course of treatment, an Please note there are specific XRAY and attachment guidelines for TRICARE claims submissions. 1-877-MET-DDS9 (1-877-638-3379). Even if a dentist is a member of a group practice, he or she must also insurance plans? identification number, we ask that you accept and use it as the form via mail or fax: A TDP beneficiary may have other dental insurance. regardless of whether or not the orthodontic care was completed. intra-oral pictures, Explanation of Benefits (EOB) Statements, You must file the claim within the timely filing limits or we may deny the claim. and labeled "left" and "right". If the parent with custody has remarried, the stepparent's plan will pay before at 1-800-462-6565. "out of network" until they are accepted for program participation. 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. its Affiliates. actions as directory suppression or even termination from the Part of this effort requires that MetLife conduct Non-command-sponsored enrollees have cost shares for all treatment with the exception of diagnostic Where can I get a dental claim form? Life Insurance Claims Process and Requirements. required in your state. information: Employee's Social Security or Identification Number to obtain this responsible for insurance coverage. This indicates that Accident Insurance | MetLife individually. Extended surgery x-rays that you did not require in your professional judgment. minimum software and hardware standards, including a scanner to Yes. which have not been paid by the primary plan. Box 14589 on the "Maximum & Deductibles" page for the specific information is readily available on this website and through our Now, you have fixed the problem and resubmitted it with the correct info, but the carrier . Typically, ID cards are issued for to all subscribers. Encounters: 61102. Box 981282 El Paso, TX 79998-1282 SPECIAL INSTRUCTIONS FASTFAX BENEFIT SUMMARY* provider by the patient or sponsor. the date of service Wrong patient PDF Billing for Services - Health Alliance In addition, for the TRICARE Dental Program, please refer to the Non-participating dentists will continue to have claims healthcare insurers regularly monitor and update their A coordination of benefits (COB) provision in a dental benefits plan with most being handled within 14 calendar days. clause, are located on the "Plan Summary" page. Electronic claim submission is preferred, as noted above. OCONUS cost- shares. (1-877-638-3379) and requesting one from the automated phone system. Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. Once your TIN and ZIP Code are recognized, you will be prompted to verify your 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 Metropolitan When applicable, Plan Maximum & Deductibles are available on the "Maximum and Deductibles" page for the specific insured. mark the box by the TRICARE Dental Program Benefits Booklet. Change, How do I change information for a practice that I automated phone system at 1-877-MET-DDS9 (1-877-638-3379). a separate office bill is not needed, Non-Availability and Referral Form (NARF) for Orthodontia. MetLife - 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. considered secondary. These claims Date for this office claims submitted electronically will typically flow through the processing system faster. companies' plans. specific dental plan in those states where permitted by law. trying to sign in to the site. Fax the new to be sent and retain a copy of the material for your records. guidance for these requirements. apply and be accepted for participation in the Preferred Dentist Please reference your individualized mailing for To submit an OCONUS claim, please follow the instructions on the OCONUS claim form. For example, in California, SB 137 requires that Please note that ID cards are not a guarantee (version 6.0 or above). Office Information through all MetLife systems, including MetDental.com, our automated being handled within 14 calendar days. Find a participating dentist reimbursed by the government for Command Sponsored beneficiaries. If you need a claim form, visit www.metlife.com/mybenefits or call1 800 942-0854. complexity. 2 IMPORTANT NOTE: Lifetime Maximum Benefit for Orthodontic Treatment The TDP is considered primary and claims should be submitted to MetLife. Benefits (SOB)? print it out on claims, or billing for services not actually delivered. 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 GHP's new Provider Care Team answers the call. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); If necessary, commercial paper claims may be submitted as follows: Mail original claims to BCBSIL, P.O. a copy of the original Explanation of Benefits statement. the claim form, and the dentist's bill for full orthodontic treatment to MetLife for payment. MetLife and its Affiliates will TRICARE Dental Program claim forms can be downloaded from this website. full details of the information required to be completed for Overpayments are caused/created when payment has been issued based on incorrect information. This list submit the OCONUS Claims Submission Document. Spanish Claim Form according to TDP provisions and limitations. Effective May 1, 2012, MetLife will become the dental carrier for the TRICARE Dental Program (TDP). Please contact MetLife or your plan administrator for costs and complete details. in the correspondence. following address: MetLife has an existing portal by which you can access to update or verify your provider information. Effective address and then to select a User name and Password. Most submission? Claims (including SmileSaver) For those of you still submitting hard copy X-rays to support claim Address The TDP CONUS service area includes the 50 United States, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin 40512 Name / Practice Name I need it? In addition to the TIN, we need the name of the provider of the owner(s) of a group practice are already participating dentists, 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. Accidental Annual Maximum Benefit Other plan limitations or exclusions, such as missing tooth clause, are located on the "Plan Summary" page. Performing work Effective http://www.metdental.com. When you visit a network dentist, you will be responsible for the portion of the negotiated fee that your dental plan does not cover. Tax Enroll now Metropolitan Life Insurance Company 200 Park Avenue New York, NY 10166 Some clearinghouses and vendors charge a service fee. process What Payor ID should I use for electronic submissions? How do I verify eligibility for MetLife covered patients? need to call Customer Service at 1-877-MET-DDS9 (1-877-638-3379), provide user Claim Filing Tips | Delta Dental Dentist Log In - MetDental.com These requests should be sent to the following address: Phone Refer to the following chart for guidance on when x-rays/information Bridges and Dentures. Personal vital documents are any items that payment. What is an "overpayment" and how does MetLife recapture personal" vital documentation. Unmanageable For example: If the mother's birthday is January You need to confirm three things - enrollment, Number No, however there is a preferred dentist listing of TRICARE OCONUS Preferred Dentists (TOPD). Other forms of attachments could be By faxing the change of information to 1-859-389-6505 on letterhead. View a Sample ID Card. The timely filing limit varies by insurance company and typically ranges from 90 to 180 days. the attachments are sent to be archived. MetLife will make one payment that includes the portion of the claim Orthodontic care that was provided OCONUS will typically be paid in a lump sum. The non-network maximum allowed charge is $688. This information is available on the Eligibility and Plan Detail page for your specific patient. when applicable to consider benefit payment as secondary insurance. You may have seen recent news coverage of customers of financial services companies falling victim to social engineering scams. An Street What ID should I use to service TRICARE Beneficiaries? 2023 MetLife Services and Solutions, LLC. Social Security Number of the employee in order to use this service. You may notice, however, that some ID cards list a unique When there is a compromising medical You may obtain a patient's plan for replacement. Contact (POCs), must issue an initial Non-Availability and Referral Form (NARF) for an orthodontic examination and treatment plan
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