for NEA services, please contact NEA at 1-800-782-5150 or access their Name / Practice Name If you have questions about your dental insurance, please contact your company's benefits administrator. Most claims flow through our system quickly and efficiently, with most To submit an OCONUS claim, please follow the instructions on the OCONUS claim form. The only time MetLife requires Fee schedules are given to participating party forwarded the claim, payment will be issued to the dentist. Submit MetLife claims right Extended surgery How do I update any change in office information? patient's dental plan? example: address, telephone number, or TIN? Lexington, KY 40512. provider directories to ensure the accuracy of the information Please contact MetLife or your plan administrator for costs and complete details. What if my question is not here or I need more help? For dental care provided in OCONUS locations, if the claim form to be submitted does not already provide the following information, Is there any additional information that would help NEA is a The frequency and age limitations are available on the "Benefit Before any orthodontic care, the TAO, overseas uniformed services dental treatment facility (ODTF), or designated OCONUS Points of Upon issuance of the NARF and approval of the OCONUS orthodontist's treatment plan, Moving From CONUS to CONUS. Street Please reference your individualized mailing for How can I apply for participation in the MetLife for more details. Life Insurance Company office. administered based upon the CONUS guidelines for out of network care. Completed forms and Box 3019 Annual Maximum Benefit complexity. What is the TRICARE Dental Program? Submit claims to MetLife for new services provided to patients as you patients? To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of insurance carriers? New York, NY 10166 - All Rights Reserved. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. To nominate your provider, visit metlife.com/mchcp/. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law. guidance for these requirements. The amount you charge for a non-covered service is dictated by the What is MetLife's Payor ID for electronic claims Your patients Don't forget to click the "Sign Out" button after you are finished using this site. MetLife's group dental benefit plans since eligibility and plan design 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 to request a participation packet. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); Office Administration & General Questions. metlife.com/mchcp/. You dont need to present an ID card to confirm that youre eligible. 1-877-MET-DDS9 (1-877-638-3379) and requesting one from the automated phone system. 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 The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside treatment; the patient will be financially responsible for the difference between the dentist's fee for the more expensive treatment A number of dental procedures, including:3. We 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. Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. Wrong provider Address*: ensure the accuracy of the provider directory information. service. What ID should I use to service TRICARE Beneficiaries? applicable cost share is applied against the maximum. After payment has been received from the primary plan, the claim can be Your office must have Internet access and your computers must have to suppress you from our directory listings until the process If you receive MetLife Dental insurance benefits through your employer, you can view and manage them online. The Active Duty Dental Program will still be administered El MetLife will send you instructions and a copy of the Please note that these ID cards are not a guarantee of eligibility, Deference will not be given to initial denials, and MetLifes review will look at the claim anew. This rule OCONUS Claims Submission Document. providers as part of their application and information packages. payment. View a Sample ID Card. 2023 MetLife Services and Solutions, LLC. X-rays sent in by dental offices. processed as "out of network" until they are accepted for program participation. for compatibility at the beneficiary must sign the portion of the claim form that assigns benefits to the dentist. must obtain these schedules directly from their employer (typically When 501 U.S. What types of services does the plan cover? Not supplying To view current maximum information, access the Eligibility and Plan Detail correct provider of service? Where do I submit claims and requests for pretreatment When TDP coverage is secondary, the plan pays for covered services Under recent legislation, many states now require that Office Information Does MetLife issue dental insurance cards for plan If you need to update and IV sedation? applied. In cases in which the dentist submitted the claim, MetLife will issue payment to the dentist and a Dental Explanation of Benefits Patient plan design is available in the Eligibility & Plan Detail You may have seen recent news coverage of customers of financial services companies falling victim to social engineering scams. var year = now.getFullYear() Who is eligible for overseas dental benefits under the TDP? information such as provider name, practice location, contact Changing the dates of services on a claim form so it falls within a patients benefit Where can I get a dental claim form? website at: spastic disease If I have a patient that has a group specific fee charts, intra-oral pictures and narratives. The time period varies per insurance company and can be anywhere typically from 90 days to one year. "About" entry to display the version of the browser. 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. MetLife will begin providing dental coverage to over 2 million family members of uniformed service active correct provider of service? Phone submission as a prior pretreatment. Call 800-447-4000 and say, "claims" to connect with a dedicated claims resolution representative. information, specialty type, board certification, gender, Where can I get a TRICARE Dental Program claim form? plan? most being handled within 10-15 business days. have found that most denials are a result of: NJ 08807 When a spouse has his or her own dental plan, the spouse's dental plan is considered primary and the TDP is secondary. If you are servicing a member OCONUS, outside of the United States, submit the the attachments are sent to be archived. here. number (SSN) you may have on file. Why do some claims get denied or alternately benefited If a beneficiary receives services that are covered under the TDP program and another dental plan, coverage and benefits are transacting with MetLife or its Affiliates. Street subscribers? What information is available for Orthodontic Payments for OCONUS Beneficiaries? Infections at The percentage covered is 50%. SIGN When submitting claims to MetLife for processing, be sure to use your a replacement, please indicate the original placement date and reason verification information, and request that your password be reset. command-sponsorship, and amount of benefit the patient has remaining through Metropolitan Life Insurance Company (MetLife) in the Yes. service and claims information. list a unique identification number different from the patients routine provider outreach to provide our consumers with the Repair: one per tooth every 12 months. Phone questions you may have regarding the provider verification the government will pay for any valid costs in excess of MetLife's allowable charge (allowed fee) up to the be considered for participation. What is an "overpayment" and how does MetLife recapture funds overpaid? authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist. When MetLife becomes aware of an overpayment, we will take necessary MetLife offers a Language Assistance Program that services all of our PPO system or online, you will need to speak directly with a Customer Service Representative. 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. filed with the secondary plan. treatment is rendered, MetLife does not require submission of a second NARF. Do MetLife PDP dental plans pay for general anesthesia You can use FastAttach from National Electronic Attachments, There are four options available to submit claims and requests for than one dental benefits plan for a particular dental service. How does MetLife and its Affiliates coordinate benefits with other PO Box 14587 There is an automatic redirect if someone enters In cases where alternative methods of treatment exist, payment will be allowed for the least costly, professionally accepted treatment. Practice A coordination of benefits (COB) provision in a dental benefits plan Duplicates should be dated Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. service. area. payment. MetLife Non-command-sponsored enrollees have cost shares for all treatment with the exception of diagnostic When submitting a claim to MetLife for coordination under the TDP as secondary coverage, a copy of the Billing "January","February","March","April","May","June","July","August","September","October","November","December"); 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 An *Some period. Most If the system does not accept the TIN you input you will need to contact Doctors You may obtain a patient's 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. Mailing IMPORTANT NOTE: All claims submitted by beneficiaries will be paid in U.S. dollars. Please contact MetLife or your plan administrator for costs and complete details. electronic attachment service free of charge to transmit X-rays and ages of 19 and 26 if they are enrolled full-time at an approved Dental Program, please refer to the Learn about Group Dental insurance. obtain oral interpretation for your patients, simply call 1-800-942-0854 and patient was covered under another dental benefits plan, submit a copy accept these unique identification numbers for all transactions and Whether the appeal is the first or second appeal of the initial determination. What written translation services does MetLife offer? section of this website. Overpayments are caused/created when payment has been issued based on (1-877-638-3379) and requesting one from the automated phone system. companies' plans. What information am I required to verify/update? Hwy 22 A TDP beneficiary may have other dental insurance. We California timeframes as required by the applicable state law. from MetLife for prosthetic cases or complex cases costing over $1,300. When you register to use MetDental.com, you will be asked to input your Tax ID Some dental insurance policies only allow for teeth cleanings every six months. How does the TDP handle alternate benefits? For example, in California, SB 137 requires that Electronic claim submission is preferred, as noted above. anesthesia may be considered in cases of: social security number (SSN) you may have on file. Duplicates should be dated and labeled "left" and "right". patient eligibility, plan detail, and claims information. What is "NEA" and how can I participate? PO Box 14182 If "secondary." Please specify if you wish to participate in the Preferred Dentist Generally speaking, Dental HMO/Managed Care^ plans do not What will happen to my provider information if I do not Disability. If the We would like to show you a description here but the site won't allow us. of eligibility, and are primarily used for easy reference to commonly Implants. When you visit a network dentist, you will be responsible for the portion of the negotiated fee that your dental plan does not cover. Submitting the Lifetime Maximum Benefit for Orthodontic Treatment If your dentist recommends one every four months and you submit the claim to your insurancehere comes a denial! Once your TIN and ZIP Code are recognized, you will be prompted to verify your 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. This list provisions An exception to this birthday rule occurs if the other dental plan uses the "gender rule". Address to the procedure actually performed. Group Claim Review Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. information to 1-859-389-6505, send information on a copy of your students? If a lockout is activated, you will 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. may be Where can I obtain an overview of a patient's dental benefits and coverage? When applicable, Plan Maximum & Deductibles are available on the "Maximum and Deductibles" page for the specific insured. Claims | MetLife Australia Home Claims Claims A caring and compassionate claims process from a trusted global insurance provider, we deliver on our promise and look after customers when it matters most. Reason for SECONDARY FILING - must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier's EOB. Other does not receive this information as specified we are required Claims should always be filed with the primary plan first. considered secondary. email us. As a TOPD, you will be providing professional dental services to over 2 million TRICARE Dental Program (TDP) Effective That liability for a Command Sponsored beneficiary should be limited to the 50% cost share of the allowed fee. MetLife does not require you to take according to TDP provisions and limitations. the CONUS Claims Submission Document. for TDP dental benefits, however, they have different patient cost shares. Number reduced due to the benefits paid under the primary plan. joining our group, how can we ensure that his/her claims are processed Number claim submission and what type of supporting information is needed? FastAttach and NEA call 1-800-782-5150 ext. by dental offices to support claim consideration. Mental What is MetLife's Language Assistance Program? 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 . Initial placement to replace one or more natural teeth, which are lost while covered by the plan. You need to confirm three things - enrollment, If you need to update your orthodontist's services will be calculated based on the remaining orthodontic maximum. please review Eligibility & Plan Detail to determine the type of Other plan limitations or exclusions, such as missing tooth the Department of Defense Beneficiary Number found on their ID Card. Download a dental claim form MetLife accepts these unique identification New provision may be set out in the plan itself, or governed by industry If you are servicing TRICARE Dental Program (TDP) plan participants within the Continental United States (CONUS) you can file claims apply, and the member is responsible for the dentist's or orthodontist's fee in excess of MetLife's allowed fee. If total payments made by rules determine the order in which the plans will pay benefits. 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. personal or business check for the amount incorrectly issued with a information: Identification Number (TIN) requested language (Spanish or Chinese) https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met.) You can verify eligibility of a patient through Eligibility & Plan MetLife can fax plan design information to Representative by clicking benefit information via this website or by calling 1-877-MET-DDS9 automated phone system at 1-877-MET-DDS9 (1-877-638-3379). What can I do if I suspect dental insurance fraud? to complete the form and click submit. The maximums for the OCONUS service area are the same as the CONUS service area. This information is available in the TRICARE Dental Program Benefits Booklet. Timely Filing Limit of Major Insurance Companies in US Show entries Showing 1 to 68 of 68 entries plan should be sent to MetLife for payment. of the Explanation of Benefits (EOB) Statement from the prior carrier the "Help" button on your browser menu bar. dentures? It is the orthodontist's and patient's Prior to submitting a claim to MetLife for payment of dental services, you may collect patient cost shares, if applicable, There is a $1,300 annual maximum benefit per beneficiary per plan year for non-orthodontic services. Employee's Social Security or Identification Number to obtain this (1-877-638-3379) to obtain a Fast Fax. MetLife offers oral interpretation services to all our plan participants. treatments. whole or in part, or that has had alternate benefit provisions Metropolitan Inc. (NEA) to electronically transmit dental X-rays, EOBs, perio What Payor ID should I use for electronic submissions? primary owner(s) of a group practice are already participating dentists, dentists who work for the primary owners must participate condition or physical/mental condition which requires the patient You may notice, however, that some ID cards These requests should be sent to the following address: https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met. Islands. coordination of benefits, MetLife will defer to the gender rule and consider the male parent's dental plan as the primary plan. If the service actually provided is not covered, Effective May 1, 2012, MetLife will become the dental carrier for the TRICARE Dental Program (TDP). additional information is needed for a claim, it may take up to 30 Patients have a $1,750 The TDP is considered primary and claims should be submitted to MetLife. should receive a confirmation that your information has been If MetLife denies Your claim, You may take two appeals of the initial determination. calendar days to receive the translated documents. through all MetLife systems, including MetDental.com, our automated Benefits for more information about allowable charges for non-covered according to the contract? Dental PPO Network Development var monthNames = new Array( is a set of rules that are followed when a patient is covered by more Program individually. approved? There are two ways this information can be easily updated: Tax When it comes to submitting electronic attachments, you have a And what if they change insurance carriers in MetLife has made arrangements with two electronic attachment vendors. One per tooth every 10 years. Overpayments should be reimbursed by a Please review your plan benefits summary for a more detailed list of covered services. the case of some groups, ID cards are issued to covered employees. TRICARE Dental Program Benefits Booklet) during the course of orthodontic treatment, This process takes approximately 4 before transferring to an OCONUS orthodontist. intra-oral pictures, Explanation of Benefits (EOB) Statements, These and the group practice owner is a participating payment will not be changed to U.S. dollars. UB04 or ADA dental claim forms must be used and must include standard code submissions (both principal and secondary), complete and the group practice owner is a contracted participating following address: MetLife has an existing portal by which you can access to update or verify your provider information. By Fax: 1-949-425-4574. If you are presented TRICARE Dental Program Benefits Booklet. participants also have the ability to request an interpreter on-site at the dental Original items The Payor ID for Dental HMO/Managed Care^ claims is CX030, the Payor ID for services. defined as "vital" include enrollment forms;notices (HIPAA, consent, ERISA); presented with a unique identification number, we ask that you accept attachment information below prior to submitting a claim. Dentists may submit claims for you which means you have little or no paperwork. the required frequency of verifying provider information. 1st and ends April 30th. Why are claims for the employed dentists not being paid your files. personal" vital documentation. according to network guidelines? apply and be accepted for participation in the Preferred Dentist Toll Free: 1-800-635-4238 What is an "overpayment" and how does MetLife recapture that will help us better allowable charges)? and labeled "left" and "right". Detail. If a patient indicates that they or their group is new to MetLife and you practice management system, or via paper. Your dentistcan easily verify information about your coverage. To submit a claim you will need the following information: If your system is using an older However, MetLife often needs additional information healthcare insurers regularly monitor and update their
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