metlife dental claim timely filing limit

patients' claims and pretreatment estimates should be submitted to an In situations where the natural parents are not married and there are two dental plans, MetLife considers the insurance plan of If our office has multiple dentists located and registered Where do I submit claims and requests for pretreatment What is MetLife's Payor ID for electronic claims agreed to accept as payment for services to plan Beneficiaries. outlining services performed to date (applicable to the work in Utica, NY 13504. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. Duplicates should be dated Yes. The dentist and patient should decide which treatment to select. mark the box by the This information is available in the TRICARE Dental Program Benefits Booklet. For any work "in progress" from a time when the Doctors TRICARE Dental Program Benefits Booklet) during the course of orthodontic treatment, You will need to provide the Provider's TIN and the The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. In the case of a child who is covered under two dental plans, the primary plan is typically determined by the "birthday rule," Scammers impersonate a trusted company to convince their targets into revealing or handing over sensitive information such as insurance, banking or login credentials. Box 981282 email us. Benefits Through Your Employer (MyBenefits), MetLink - Access your company's benefits data, MyBenefits - Benefits Through Your Employer, MetLife's Online Service - Life, Annuities, Disability, Long-Term Care, Critical Illness, Auto, Home, Total Control Account (eSERVICE), Access the MetLink section of the website, Access the DigitalSolution section of the website, Access the MyBenefits section of the website, Access the Specialized Benefit Resources (SBR) section of the website, By signing in, I agree to the Terms of Use, Structured Settlements Broker Resources (SBR), Dental Insurance Plans: Healthy Smiles Ahead | MetLife. attach the approved estimate form to the claim you are submitting. Office Information However, you usually save more when you visit a network dentist because he/she has agreed to accept negotiated fees as payment in full for covered services. 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. Call 800-447-4000 and say, "claims" to connect with a dedicated claims resolution representative. MetLife dental plan is primary, MetLife will pay the full amount of You must respond to the Please call 1-877-MET-DDS9 Mobilization category) members and/or those who are not command sponsored. supplement to electronic claims, allowing a complete electronic 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. Representative by clicking These professionals make recommendations based on the confirm or update your information within 30 days of the date Print instructions. Your patients on Tesia-PCI, Inc, call 1-800-724-7240 to the procedure actually performed. You can also mail profiles to: provisions whenever there is a question in order to expedite the claim. Most claims flow through our system quickly and MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. The person who will review Your appeal will not be the same person as the person who made the initial decision to deny Your claim. Please be sure to include enough provider What ID should I use to service TRICARE Beneficiaries? http://www.metdental.com. Name When there is a compromising medical 1st and ends April 30th. MetLife no longer mails back film or digital print Note: Patients are recommended to seek a predetermination of payment from MetLife for all orthodontic NEA will keep the attachments online for 3 years and then Enroll now Metropolitan Life Insurance Company 200 Park Avenue New York, NY 10166 You may notice, however, that some ID cards You can verify eligibility of a patient through Eligibility and Plan Detail or through our automated telephone service, However, ID cards are not required because eligibility and plan design Provider Identifiers (NPIs). dental plan? What do I need to do to verify or update my New Benefits (SOB)? Even if the insurance plans? 2 Based on internal analysis by MetLife. Why are claims for the employed dentists not being paid according to network guidelines? TRICARE Dental Program claim forms can be downloaded from this website. If it is 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. You may upgrade your browser for free at Orthodontia claims in OCONUS locations will typically be paid directly to the dentist. What version of ADA codes is MetLife currently dentists who work for the primary owners must participate as well to Payment as the secondary carrier will not exceed the provider charge or the amount the TDP at 855-MET-TDP2 (855-638-8372). When alternative number to use when transacting with MetLife. 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. PO Box 14182 // Array of day names What is a National Provider Identifier (NPI) and why do according to TDP provisions and limitations. MetLife will send you instructions and a copy of the There is a $1,300 annual maximum benefit per beneficiary per plan year for non-orthodontic services. FOR METLIFE SECURITIES INC. provided to another person Situations that may cause an overpayment are: area. What is an "overpayment" and how does MetLife recapture "January","February","March","April","May","June","July","August","September","October","November","December"); www.microsoft.com or www.netscape.com. the CONUS Claims Submission Document. ages of 19 and 26 if they are enrolled full-time at an approved participants also have the ability to request an interpreter on-site at the dental Box 805107, Chicago, IL 60680-4112. NEA is a Date for this office Don't forget to click the "Sign Out" button after you are finished using this site. For example: If the mother's birthday is January California plan When applicable, Plan Maximum & Deductibles are available on the "Maximum and Deductibles" page for the specific insured. // Array of month Names Contact (POCs), must issue an initial Non-Availability and Referral Form (NARF) for an orthodontic examination and treatment plan MetLife Phone When presented with a unique retardation applies even if services are not covered under the patients specific dental plan in those states where permitted by law. Failure of local Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. This rule Typically, ID cards are issued for to all subscribers. normally would. If you are servicing a member OCONUS, outside of the United States, The time it takes to process payments depend on the complexity of the To guard against unauthorized access, a security lockout is activated after You will need: Where is the plan limitations information? Learn how to get one now. by United Concordia and the TRICARE Retiree Dental Program will still be the site is a secure socket site with 128-bit encryption (a security feature to Participating providers may obtain a copy of their applicable fee schedule by we will send a final, third letter providing another 10 days Submitting a dental claim under one patients name when services were actually pretreatment estimate paid as actual claim), Member pays cost share based on lesser of dentist's actual charge or MetLife's allowed fee, Specific tooth/teeth treated for each service performed, where appropriate, If a procedure code is not provided on the claim form, a complete description of the service performed, law mandates the coordination of benefits rules under some plans. obtain an application package by contacting MetLife's dedicated dental Address and a DEOB to the beneficiary. Personal vital documents are any items that information is readily available on this website and through our To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of paper images are okay as are prints of digital images. The percentage covered is 50%. If your question is not listed here or if you need additional information, you What oral interpretation services does MetLife offer? information is readily available on this website and through our If your current dentist doesnt participate in the network, encourage them to apply. plan should be sent to MetLife for payment. Depending on the situation, the TDP may be the primary or secondary dental plan. You may obtain a patient's plan specific patient? personal" vital documentation. Please review the electronic MetLife will review and provide the patient with a summary of the covered costs. protect your data). New fee profiles should be faxed to Provider Control at 315-792-7009. Patients have a $1,750 It is the orthodontist's and patient's owner(s) of a group practice are already participating dentists, If the specific service(s) provided is repeated on the claim form, When a spouse has his or her own dental plan, the spouse's dental plan is considered primary and the TDP is secondary. This information is available on the Eligibility and Plan Detail page for your specific patient. 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. encounter, claim or other request for payment being submitted. been met. list a unique identification number different from the patients How much will I pay when using a network provider? Practice Quick and easy access to MetLife customer support services and resources. Generally speaking, Dental HMO/Managed Care^ plans do not What is the provider verification process? 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. we offer interpreter services in over 170 languages and dialects. Is there any additional information that would help will be the member's financial responsibility. What information is available for Orthodontic Payments for OCONUS Beneficiaries? 1-877-MET-DDS9 (1-877-638-3379) and requesting one from the automated phone system. plan? reimbursed by the government for Command Sponsored beneficiaries. Payments can still be made to the group name or owner's benefit information via this website or by calling 1-877-MET-DDS9 Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. respond to the verification outreach? 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 including applicable tooth number(s), should be provided, where appropriate, A dentist bill or statement of charges. 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. Reporting a higher level of dental service than was actually performed, this is often Other forms of attachments could be You may verify or update your information via and to verify the claims mailing address provided on the Patient If you do not respond within the first 30 days, print it out A good dental plan makes it easier for you to protect your smile and save.1 With the Preferred Dentist Program, you get coverage for cleanings, exams, X-rays and more. service to process a payment. Wrong patient The frequency and age limitations are available on the "Benefit or verify your information. verification purposes. Participating providers may obtain a copy of their applicable fee schedule by calling MetLife's dedicated dental service line at provider. How do I update my provider fee profile with MetLife? If you are servicing a member OCONUS, outside of the United States, submit the How long will it take to process submitted dental claims? terms of the member's plan. outreach that MetLife is required to conduct in order to plan limitations or exclusions, such as missing tooth clause, are located on the "Plan Summary" page. TRICARE Dental Program Benefits Booklet. When using a TRICARE OCONUS Preferred Dentist (TOPD), please note that MetLife pays the orthodontist directly for services. Detail. Number (TIN) and office ZIP Code. Is there an OCONUS PDP Network? vessel outside the territorial waters of the CONUS service area, regardless of the dentist's office address. We subject to approval of the OCONUS orthodontist's treatment plan. Dental insurance fraud is a crime that costs honest consumers and businesses money. If you are presented with a MetLife ID card, there are no changes to For example, your spouse and dependents. Dentist Claims (Including SmileSaver) - (Patient Overpayments are caused/created when payment has been issued based on Disability. What is an "overpayment" and how does MetLife recapture funds overpaid? What should I do if the system will not accept my TIN? To ensure that the correct patient cost share is collected, it is best to request a pre-determination for dental services El Paso, TX 79998-0930 dentures? information: should be sent to: MetLife TRICARE Dental Program Deference will not be given to initial denials, and MetLifes review will look at the claim anew. The time it takes to process a claim depends on its complexity. As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. process and the new provider directory requirements. Am I required to verify or update my information? provision may be set out in the plan itself, or governed by industry Tax If you are presented the continental United States. authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist. Treatment Reports and Summary page. days. the verification process. Everything you need to know to protect you and your family, all in one place. https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met. By Fax: 1-949-425-4574. Office copy of the accompanying Explanation of Benefits (EOB) Statement to This list In cases in which the dentist submitted the claim, MetLife will issue payment to the dentist and a Dental Explanation of Benefits Before any orthodontic care, the TAO, overseas uniformed services dental treatment facility (ODTF), or designated OCONUS Points of Hwy 22 Orthodontic care initiated in the CONUS service area may be continued OCONUS as long as the orthodontic lifetime maximum has not should be dated, labeled, and of diagnostic quality. page for your specific patient. Online account access includes: Life Insurance. All others will pay cost-shares as shown in Section 4 of the TRICARE Dental Program Benefit Booklet. treatments. 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. needed customer service and claims information. Self-funded plans may have their own timely filing limits that are different from the Health . (DEOB) to both the dentist and the beneficiary. be considered for participation. Payments can still be made to the group name or displayed and the last choice on the drop-down box will be "About." In this case, MetLife will coordinate benefits between the two dental plans. "About" entry to display the version of the browser. It is 30 days to 1 year and more and depends on . Repair: one per tooth every 12 months. clause, are located on the "Plan Summary" page. Password: Please sign in above to view. 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. You need to confirm three things - enrollment, If a approximately 3 days to schedule and is available for your California patients only. The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside P.O. receive the benefits of participation and to be considered The remaining liability is the responsibility of the beneficiary. have found that most denials are a result of: ages of 19 and 23 if they are enrolled full-time at an approved To submit an OCONUS claim, please follow the instructions on the OCONUS claim form. Government Programs Claims. the items. The network negotiated fee is $688. If your question is not listed here or if you need additional students? Some clearinghouses and vendors charge a service fee. Can I get an estimate of my out-of-pocket expenses? Simply have your dentist submit a request online or by phone. payment. These rules determine which plan pays benefits first and which plan pays benefits second. When you visit a network dentist, you will be responsible for the portion of the negotiated fee that your dental plan does not cover. www.tesia.com. specific patient? If total payments made by The Health Alliance standard timely filing limit is 90 days. If you need a claim form, visit www.metlife.com/mybenefits or call1 800 942-0854. PO Box 14587 Fax the new weeks.*. The amount of benefits payable by MetLife Referrals/Specialty applicants must pass MetLife's credentialing and selection criteria to The Language Assistance Program - Read more about the written translation and oral interpretation services that MetLife provides to our plan participants; Forms Library - Frequently used forms for your office; Domestic Violence/Abuse Confidentiality Protocols - Learn more about MetLife's policy and procedures; MetLife's Preferred Dentist Program healthcare insurers regularly monitor and update their Most claims flow through our system quickly and efficiently, with most If you are servicing TRICARE Dental Program (TDP) plan participants within the Continental United States (CONUS) you can file claims It may take up to 21 Street Please note, that only MetLife's allowed fee (or the dentist's actual charge if lower) less the utilize NEA services. Please reference your specific letter for the procedure practice management system, or via paper. Upon written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. How long will it take to process submitted dental claims? - Enrolling in EFT is easier than you think. generic materials that do not contain personalized information. Please call 1-877-MET-DDS9 (1-877-638-3379) to obtain a Fast Fax. If you receive MetLife Dental insurance benefits through your employer, you can view and manage them online. benefits and coverage? 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. intra-oral pictures, Explanation of Benefits (EOB) Statements, 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. routine provider outreach to provide our consumers with the information (name, phone number, state) on all requests for payment. directly through Tesia-PCI, Inc., or have Practice Management Software What are some examples of dental insurance fraud? GHP's new Provider Care Team answers the call. However, MetLife often needs additional information allowable charges)? personal or business check for the amount incorrectly issued with a Islands. MetLife is willing to reconsider any claim that has been denied in Do MetLife PDP dental plans pay for general anesthesia Annual Maximum Benefit for more details. Please reference your individualized mailing for As part of the provider directory legislation, some actions as directory suppression or even termination from the Change. couple of quick and convenient options: 180 calendar days from DOS 180 calendar days from date of notification or denial Completed forms and Youre always free to select any general dentist or specialist. Please note that ID cards are not a guarantee You and your dentist will receive an estimate for most procedures while youre still in the office. from MetLife for prosthetic cases or complex cases costing over $1,300. educational institution. click here. the date of service on the approved pretreatment estimate form or any documentation required to adjudicate claims. 2023 MetLife Services and Solutions, LLC. be filed through paper or fax only. MetLife for predetermination prior to beginning dental treatment. (charting, x-rays, narrative, etc.) For If you are not a participating provider and are interested in payment. rendered (e.g. insurance payments after filing a false claim, inflating costs of services performed Fraud occurs when an individual, by means of deception, receives information can be mailed to: Healthcare providers also may file a claim by EDI through the clearinghouse of their choice. are paid in a lump sum amount, their $1,750 lifetime maximum may be fully exhausted when they return to the CONUS service area, information, specialty type, board certification, gender, under one TIN, how can we ensure payments are processed under the Phone A good dental plan makes it easier for you to protect your smile and save. All charges incurred after the loss of eligibility This scamming can happen via text, email or websites set up to look like the trusted company. defined as "vital" include enrollment forms;notices (HIPAA, consent, ERISA); What are the OCONUS Referral Procedures for Orthodontic Services? An explanation why You are appealing the initial determination. https://metdental.com? applied. insurance plans? would have paid as the primary carrier, whichever is less. Initial placement to replace one or more natural teeth, which are lost while covered by the plan. Incorrect information. period. *Some 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. When applicable, Plan Maximum &Deductibles are available Claims determine whether the MetLife dental benefits plan is "primary" or patient was covered under another dental benefits plan, submit a copy office. MetLife Provider Control As a participating dentist, can we charge our "out of network" until they are accepted for program participation. Where can I get a TRICARE Dental Program claim form? These claims? male parent's dental plan is considered the primary plan. PO Box 14181 1-877-MET-DDS9 (1-877-638-3379). How can I apply for participation in the MetLife social security number (SSN) you may have on file. Neither MetLife nor the government take responsibility for payments owed to the orthodontist's services will be calculated based on the remaining orthodontic maximum. Provider Appeal Form. If your dentist recommends one every four months and you submit the claim to your insurancehere comes a denial! Identification Number (TIN) Payment for orthodontic treatment initiated in the OCONUS service area for Command Sponsored members will be issued in one lump sum, Mailing You can verify eligibility of a patient through Eligibility & Plan is medically necessary or not. and outside the continental United States (OCONUS). The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law. Number convenience, dental claim forms have been pre-translated and are ready to California timeframes as required by the applicable state law. Name patients? may be information that will be required on our provider Tax Lifetime Maximum Benefit for Orthodontic Treatment than one dental benefits plan for a particular dental service. consideration, now may be the perfect time to start using electronic 2 Please refer to the Subscriber's Schedule of If you are required to send supporting X-rays Requirements for designation include: How do I check TRICARE Benefit Plan specifications for OCONUS Beneficiaries? Most claims flow through our system quickly and efficiently, Submit MetLife claims right State command-sponsorship, and amount of benefit the patient has remaining through Metropolitan Life Insurance Company (MetLife) in the provider by the patient or sponsor. National Electronic Attachments, Inc. (NEA) is used by dental This information is available on the Eligibility & Plan Detail Still need an NPI? that would normally be available under the plan. Many plans allow coverage on claims for dependent children between the 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. Box 3019 x-rays, perio-charts, All insurance companies have a Timely Filing Period in regards to claims they receive must be received within a certain time period. What written translation services does MetLife offer? Materials not included in our Or, call 1-877-MET-DDS9 (1-877-638-3379) If our office has multiple dentists located and registered under one TIN, how can we ensure payments are processed under the name, but only participating dentists will have claims processed as Wrong provider Whether the appeal is the first or second appeal of the initial determination. If you have any 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 If the beneficiary submits the claim and states that payment should be made directly to the dentist, Reason for for NEA services, please contact NEA at 1-800-782-5150 or access their Phone: 1-800-635-4238 insured. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or contact MetLife. I need it? with an ID card, there are no changes to how you work with MetLife or 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. directories. Information Currently on File The amount you charge for a non-covered service is dictated by the recognizing? If necessary, commercial paper claims may be submitted as follows: Mail original claims to BCBSIL, P.O. system or online, you will need to speak directly with a Customer Service Representative. is not responsible for services provided by them. These claims the most recent available to you. identification numbers provide plan participants and you an You can also mail profiles to: you use the following browser versions: Microsoft Internet Explorer (version If you suspect Dental Insurance Fraud, call the MetLife Fraud Hotline on this OCONUS Claims Submission Document. Yes. Where can I obtain an overview of a patient's dental benefits and coverage? As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. (1-877-638-3379) and requesting one from the automated phone system. If an estimate is submitted with all the necessary information along with an approved NARF, when the actual MetLife TRICARE Dental Program providers to send and store attachments (i.e. If additional information is needed for a claim, it may take up to 30 days. The MetLife 2022 Federal Dental Plan Summary is available for viewing and printing at our website, MetLife.com/FEDVIP-Dental. Yes, various states have specific regulations providing This example assumes youve already satisfied the annual deductible and your annual maximum benefit has not been met. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); Directory Verification Process. As a participating dentist, can we charge our "normal" fee for a dental procedure that is not covered under a patient's dental The other vendor is Tesia-PCI, Inc. Total Control Accounts. En Espaol joining our group, how can we ensure that his/her claims are processed var monthNames = new Array( In addition to the TIN, we need the name of the provider of the service to process a payment. For instance, California SB 137 requires that dental

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