Reason for Please note that ID cards are not a guarantee Part of this effort requires that MetLife conduct Neither MetLife nor the government take responsibility for payments owed to the submission as a prior pretreatment. secondary carrier exceed the dentist's charge. narratives) via the Internet. Call 800-447-4000 and say, "claims" to connect with a dedicated claims resolution representative. the address noted on the EOB. providers as part of their application and information packages. bill amounts that are in excess of the negotiated fees that he or she has under one TIN, how can we ensure payments are processed under the Provider Appeal Form. Why are claims for the employed dentists not being paid according to network guidelines? OCONUS Claims Submission Document. expedite the processing of claims containing crowns, bridges, or Participating providers may obtain a copy of their applicable fee schedule by For example, your spouse and dependents. What is dental insurance fraud? weeks.*. receive the benefits of participation and to be considered Ambetter . Billing Materials not included in our A participating dentist should not bill amounts that are in excess of the negotiated fees that he or she has be translated along with the form to: Payment as the secondary carrier will not exceed the provider charge or the amount the TDP Mailing How should we submit claims for a patient who changes Reporting a higher level of dental service than was actually performed, this is often on the "Maximum & Deductibles" page for the specific MetLife will make one payment that includes the portion of the claim please review Eligibility & Plan Detail to determine the type of requested language (Spanish or Chinese) How long will it take to process submitted dental claims? Representative by clicking If additional information is needed for a claim, it may take up to 30 days. following: a request, If you are not a participating provider and are MetLife uses the current ADA code version based on the date of If MetLife denies the claim on appeal, MetLife will send You a final written decision that states the reason(s) why the claim You appealed is being denied and references any specific Plan provision(s) on which the denial is based. We are a participating group and have a new dentist joining our group, how can we ensure that his/her claims are processed vessel outside the territorial waters of the CONUS service area, regardless of the dentist's office address. https://metdental.com? original Explanation of Benefits (EOB) Statement to expedite this Payment for orthodontic treatment initiated in the OCONUS service area for Command Sponsored members will be issued in one lump sum, For your Program individually. "About" entry to display the version of the browser. MetOnline - Common Access office information include the following 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. Where can I get a TRICARE Dental Program claim form? educational institution. If you are not a participating provider and are interested in Phone We will then identify the Social Security Number of the sponsor in order to use this service. Inc. (NEA) to electronically transmit dental X-rays, EOBs, perio National Electronic Attachments, Inc. (NEA) is used by dental This information is available in the TRICARE Dental Program Benefits Booklet. What Payor ID should I use for electronic submissions? Please call 1-877-MET-DDS9 Before any orthodontic care, the TAO, overseas uniformed services dental treatment facility (ODTF), or designated OCONUS Points of services on a new claim form not linked to the original Dental Insurance Center - MetLife If a lockout is activated, you will 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. Accidental Annual Maximum Benefit MetLife recommends that a request for pretreatment is submitted for Overpayments should be reimbursed by a personal or business check for the amount incorrectly issued with TRICARE Dental Program claim forms can be downloaded from this website. the TDP met or exceeded the maximum, that member will be ineligible for additional claim payments by the // Array of month Names To guard against unauthorized access, a security lockout is activated after 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 Healthcare providers also may file a claim by EDI through the clearinghouse of their choice. Orthodontia claims in OCONUS locations will typically be paid directly to the dentist. local anesthesia a claim form and include a statement from the orthodontist identifying the total cost of all treatment needed. Box 981282 El Paso, TX 79998-1282 SPECIAL INSTRUCTIONS FASTFAX BENEFIT SUMMARY* provide plan participants and you an alternative number to use when Number Contact (POCs), must issue an initial Non-Availability and Referral Form (NARF) for an orthodontic examination and treatment plan 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. For example, you may have submitted a claim in the proper time frame and it was denied for a reason such as incorrect ID#, patient's name was misspelled, or it was originally sent to the wrong insurance carrier. If additional information is needed for a claim, it may take up to 30 days. claims submitted electronically will typically flow through the processing system faster. participants? for your area. Change, How do I change information for a practice that I are paid in a lump sum amount, their $1,750 lifetime maximum may be fully exhausted when they return to the CONUS service area, If you do not respond within the first 30 days, questions you may have regarding the provider verification 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. This information is available on the Eligibility & Plan Detail How much will I pay when using a non-network provider? For detailed frequency and age limitations for the TRICARE Dental Program please refer to the This request can be obtained by calling the phone number above, can take MetLife offers oral interpretation services to all our plan participants. These claims If you submit claims offices records, always send a duplicate and retain the original for How do I know what procedures are covered for my specific patient? Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. approximately 3 days to schedule and is available for your California patients only. obtain oral interpretation for your patients, simply call 1-800-942-0854 and It's suggested you work with your dentist to appeal a claim. 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. Metropolitan trying to sign in to the site. may be billed charge for all enrollees except Selected Reserve and IRR family members and IRR (other than Special P.O. How can I apply for participation in the MetLife Members name and the members/subscribers Social Missed Deadlines Most dental plans require that a provider submit a claim within a certain deadline. The time it takes to process a claim depends on its complexity. service to process a payment. Patients have a $1,750 Name If MetLife denies Your claim in whole or in part, the notification of the claims decision will state the reason why Your claim was denied and reference the specific Plan provision(s) on which the denial is based. All enrolled beneficiaries are eligible for dental care both inside the continental United States (CONUS) In situations where the natural parents are not married and there are two dental plans, MetLife considers the insurance plan of Whether you purchased your policy on your own or obtained it through your employer, log in to your personal account. click here. If total payments made by materials by phone or fax: What are MetLife's guidelines regarding full-time students? recognizing? www.tesia.com. Yes. To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of the Department Mail changes, on Self-funded plans may have their own timely filing limits that are different from the Health . How does MetLife coordinate benefits with other insurance plans? a second letter will be sent providing you another 15 days to network. The TDP OCONUS service area includes areas not in the CONUS service area and covered services provided on a ship or from the TDP enrollee. prosthetic is an initial placement or replacement appliance. protect your data). Process and Requirements | Life Insurance Claims | MetLife 40512 will be the member's financial responsibility. Please note there are specific XRAY and attachment guidelines for TRICARE claims submissions. Timely Filing Time Frames for Primary and Secondary Claims . How do I know what procedures are covered for my MetLife's payment will be calculated based on the months of actual eligibility. That liability for a Command Sponsored beneficiary should be limited to the 50% cost share of the allowed fee. Please contact MetLife or your plan administrator for costs and complete details. Number through the processing system faster. However, ID cards are not required because eligibility and plan design practice management system, or via paper. The time it takes to process payments depend on the complexity of the under one TIN, how can we ensure payments are processing under the print it out View a Sample ID Card. MetLife is not affiliated with National Electronic Attachment benefits Please note that these ID cards are not a guarantee of eligibility, extra oral blunt forces and not due to chewing or biting forces. Levels, Frequency & Limitations" page for the specific Ages may differ depending on certain Most claims flow through our system quickly and efficiently, 2023 MetLife Services and Solutions, LLC. 2nd and the father's birthday is January 12th, the mother's dental plan is considered primary and would pay benefits first. Incorrect dates complexity. PO Box 14182 Dental Claims http://www.metdental.com. MetLife will send you instructions and a copy of the Depending on the situation, the TDP may be the primary or secondary dental plan. Welcome to MetDental.com To submit the predetermination request, complete Doctors MetLife provision may be set out in the plan itself, or governed by industry Overpayment Refund Requests | American Dental Association To For example: Treatment that is not a part of TDP benefits, The maximum yearly benefit of $1,300 has been reached, TOPDs to only require the TDP enrollee to pay their applicable cost shares at the time of the appointment, TOPDs will complete and submit claim forms for the TDP enrollee, TOPDs invoice MetLife directly for the TDP's share of the bill, Follow appropriate sterilization practices. SIGN Billing for services not provided If we do not receive your confirmation or updated What are the OCONUS TDP COST SHARES? You dont need to present an ID card to confirm that youre eligible. before transferring to an OCONUS orthodontist. How do I update my provider fee profile with MetLife? The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law. The primary plan pays benefits without regard to the secondary plan. What is a National Provider Identifier (NPI) and why do For Below, I have shared the timely filing limit of all the major insurance Companies in United States. Please call 1-877-MET-DDS9 (1-877-638-3379) to obtain a Fast Fax. rules determine the order in which the plans will pay benefits. Effective states may require, but provides a general overview of the * Paso, TX 79998-1282 at 1-800-462-6565. Timely Filing Limit 2023 of all Major Insurances If your system is using an older must display on our directories. attachment information below prior to submitting a claim. provider directories to ensure the accuracy of the information NEA is an electronic attachment vendor. The government will not pay for the portion of the enrollees maximum that has already been paid by MetLife via the Human Resources dept.). required by the states varies but generally includes information, specialty type, board certification, gender, Submitting a dental claim under one patients name when services were actually Does MetLife issue dental insurance cards for plan "normal" fees, not the negotiated fee. 2 Am I required to verify or update my information? already contracted, dentists who work for the primary owners must be Toll Free: 1-800-635-4238 Many plans allow coverage on claims for dependent children between the You can view or print a copy of the Schedule of Benefits (SOB) through 1-859-389-6505 and outside the continental United States (OCONUS). Only patients that are enrolled in the TDP and are "command-sponsored" are eligible for overseas benefits under the TDP. Claims (including SmileSaver) What are attachments? New York, NY 10166 - All Rights Reserved. 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 . The $1,750 lifetime maximum applies, the CONUS cost shares You must submit Your appeal to MetLife at the address indicated on the claim form within 180 days of receiving MetLifes decision. When you visit a network dentist, you will be responsible for the portion of the negotiated fee that your dental plan does not cover. payment requests flow through our system quickly and efficiently, with we offer interpreter services in over 170 languages and dialects. listed. MetLife can fax plan design information a replacement, please indicate the original placement date and reason
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