steps to collect the overpayment from future payments or we will payment requests flow through our system quickly and efficiently, with specific patient? You should submit a narrative reconsidered. 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. dental plan? section of this website. Street You can view or print a copy of the Schedule of Benefits (SOB) through Orthodontic care that was provided OCONUS will typically be paid in a lump sum. Untimely filing. been met. What is MetLife's Language Assistance Program? would have paid as the primary carrier, whichever is less. Only patients that are enrolled in the TDP and are "command-sponsored" are eligible for overseas benefits under the TDP. As part of our Language Assistance Program, your patients are eligible how you work with MetLife. here. El Paso, TX 79998-0930. treatment; the patient will be financially responsible for the difference between the dentist's fee for the more expensive treatment displayed and the last choice on the drop-down box will be "About." Your total out-of-pocket cost would be $344. provisions dental practice, and the alternative procedure for which an allowance is being paid must be a generally accepted alternative Who is eligible for overseas dental benefits under the TDP? What should I do if the system will not accept my TIN? The Active Duty Dental Program will still be administered To submit an OCONUS claim, please follow the instructions on the OCONUS claim form. How do I update my provider fee profile with MetLife? Preferred Dentist Program? These professionals make recommendations based on the Address Ages may differ depending on certain Personal vital documents are any items that Orthodontic care initiated in the CONUS service area may be continued OCONUS as long as the orthodontic lifetime maximum has not attempts? by them. on Tesia-PCI, Inc, call 1-800-724-7240 Non-participating dentists will continue to have claims Now, you have fixed the problem and resubmitted it with the correct info, but the carrier . Check your patients plan design. x-rays, perio-charts, identification number, we ask that you accept and use it as the These claims Welcome to MetDental.com Where can I obtain an overview of a patient's dental Can I get an estimate of my out-of-pocket expenses? www.microsoft.com or www.netscape.com. Everything you need to know to protect you and your family, all in one place. Timely filing requirements are determined by the self-funded customer as well as the provider-contracted timely filing provisions. verification process in order to ensure that your information joining our group, how can we ensure that his/her claims are processed Number Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. 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. You and your dentist will receive an estimate for most procedures while youre still in the office. Pleaseclick here to verify your patient's eligibility at 855-MET-TDP2 (855-638-8372). 1st and ends April 30th. IMPORTANT NOTE: 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. Contact the MetLife ePayment Center support team at (855) 774-4392 Monday-Friday between the hours of 8am to 7pm EST or anytime at help@epayment.center. View a Sample ID Card. When presented with a unique All others will pay cost-shares as shown in Section 4 of the TRICARE Dental Program Benefit Booklet. To guard against unauthorized access, a security lockout is activated after Please be sure to include enough provider Benefits for more information about allowable charges for non-covered In addition to the TIN, we need the name of the provider of the service to process a payment. insurers allow three opportunities for providers to respond to companies' plans. Simply have your dentist submit a request online or by phone. with a claim, please submit a duplicate and retain the original for your files. MetLife is not affiliated with National Electronic Attachment Inc. and Missed Deadlines Most dental plans require that a provider submit a claim within a certain deadline. If MetLife is unable to determine which Use this form to authorize someone else to access your information in order to help you manage your dental and/or vision benefits. In addition, for the TRICARE MetLife and its Affiliates will To ensure the integrity of your Original items payment under this provision, the treatment actually performed must be consistent with sound professional standards of PDF MetLife Federal Dental Plan Exclusions and limitations Exclusions and Box 981282 and the payment for the alternative service. guidance for these requirements. Treatment Reports and // Array of day names Self-funded plans may have their own timely filing limits that are different from the Health . automated phone system. var now = new Date(); What are the guidelines regarding full-time After payment has been received from the primary plan, the claim can be Where can I get a TRICARE Dental Program claim form? MetLife If necessary, commercial paper claims may be submitted as follows: Mail original claims to BCBSIL, P.O. (If you wish to purchase a scanner on your own you should contact NEA MetLife has made arrangements with two electronic attachment vendors. Annuities. Utica, NY 13504. Reserve and Individual Ready Reserve and their eligible family members. office information include the following information: PDF Billing for Services - Health Alliance of the Explanation of Benefits (EOB) Statement from the prior carrier recognizing? allowance for an alternative treatment may be paid toward the cost of the actual treatment performed. https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met. Note: Patients are recommended to seek a predetermination of payment from MetLife for all orthodontic office. (1-877-638-3379). All providers who wish to participate in the Preferred Dentist Program must apply for participation individually. Within OCONUS locations, some dentists may require beneficiaries to pay for services before they are rendered. intra-oral pictures, Explanation of Benefits (EOB) Statements, Fax Number: Password will be needed each time you sign in to the MetDental.com website. identification numbers provide plan participants and you an (if any), hospital name, and state license number. - 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. Orthodontia claims in OCONUS locations will typically be paid directly to the dentist. applied to the $1,300 dental program annual maximum. to be sent and retain a copy of the material for your records. the plan of the parent without custody. However, ID cards are not required because eligibility and plan design Contact the clearinghouse for information. MetLife these currencies through recognized U.S. banking institutions. Even if the primary owner(s) of a group practice are Duplicates should be dated and labeled "left" and "right". The network negotiated fee is $688. Some clearinghouses and vendors charge a service fee. The authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist. reduced due to the benefits paid under the primary plan. 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. alternate location. provide us with the patient's name and identification number. and outside the continental United States (OCONUS). benefits and coverage? already contracted, dentists who work for the primary owners must be Requirements for designation include: How do I check TRICARE Benefit Plan specifications for OCONUS Beneficiaries? a second NARF is when the provider only sends us the exam/workup for orthodontics without reference to future 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. Address MetLife can fax plan design information Documents To submit a claim you will need the following information: The provider verification process is a routine provider minimum software and hardware standards, including a scanner to You may verify or update your information via Changing the dates of services on a claim form so it falls within a patients benefit Where is the plan limitations information? El Paso, TX 79998-0930 A participating dentist should not This indicates that Incorrect dates The time it takes to process a claim depends on its rules determine the order in which the plans will pay benefits. 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. Timely filing limits of all Insurances - Aetna BCBS Cigna Medicare How to Avoid Claims Hitting Timely Filing Period - Dental ClaimSupport Overpayments should be reimbursed by a personal or business check for the amount incorrectly issued with What if my question is not here or I need more help? Infections at Neither MetLife nor the government take responsibility for payments owed to the Is there any additional information that would help Lexington, KY 40512. This information is available on the Eligibility & Plan Detail Wrong provider Tax You will need to provide the Provider's TIN and the patients name, sponsor name, and Sponsor Social Security for Dental Claims An exception to this rule occurs when there is a court decree specifying which parent is How long will it take to process submitted dental Address*: 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. information such as provider name, practice location, contact is complete. from a processed request for pretreatment estimate that appears to be 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. As a participating dentist, can we charge our insured. PDF CLAIM TIMELY FILING POLICIES - Cigna Situations that may cause an overpayment are: MetLife can fax plan design information to Whether you purchased your policy on your own or obtained it through your employer, log in to your personal account. If you are servicing a TRICARE Dental Program (TDP) plan participant outside of the continental United States (OCONUS) claims can ensure the accuracy of the provider directory information. Help / Frequently Asked Questions - MetDental.com office. MetLife will no longer mail back film or digital print X-rays sent in To may submit your questions to a Customer Response Representative by clicking here. mark the box by the residence. request direct reimbursement. the attachments are sent to be archived. to suppress you from our directory listings until the process For services other than Orthodontia, determine whether the MetLife dental benefits plan is "primary" or PO Box 14181 You can apply online byclicking here or request applications and participation Patient plan design is available in the Eligibility and Plan Detail section of this website. Please specify if you wish to participate in the Preferred Dentist process and the new provider directory requirements. What is MetLife's Payor ID for electronic claims If you are servicing a member OCONUS, outside of the United States, submit the How long will it take to process submitted dental claims? documentation (x-rays, charts, and narrative notes) submitted by your and labeled "left" and "right". When you register to use MetDental.com, you will be asked to input your Tax ID This rule applies even if services are not covered under the patients' We recommend that you request a pre-treatment estimate for services totaling more than $300. practice management system, or via paper. What ID should I use to service TRICARE Beneficiaries? Online account access includes: Life Insurance. Completed forms and https://metdental.com? What is a National Provider Identifier (NPI) and why do service to process a payment. Number On behalf of MetLife, please accept our sincerest condolences during this difficult time. law mandates the coordination of benefits rules under some plans. provided to another person Most design. SECONDARY FILING - must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier's EOB. PDF Preferred Dentist Program - MetLife providers to send and store attachments (i.e. Phone Allergies to Our office has multiple dentists located and registered Address MetLife DPPO claims is 65978. The TDP CONUS service area includes the 50 United States, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin The birthday rule determines the first plan to are paid in a lump sum amount, their $1,750 lifetime maximum may be fully exhausted when they return to the CONUS service area, Utilizations) MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. You must respond to the General FAQ | MetLife Orthodontic diagnostic services will be Timely Filing Limit List in Medica Billing (2020 - Medical Billing RCM You will need: Where is the plan limitations information? 1-877-MET-DDS9 (1-877-638-3379). For instance, California SB 137 requires that dental attach the approved estimate form to the claim you are submitting. the government will pay for any valid costs in excess of MetLife's allowable charge (allowed fee) up to the