MetLife offers oral interpretation services to all our plan participants. directories. Please call 1-877-MET-DDS9 1-859-389-6505 the address noted on the EOB. Office reimbursed by the government for Command Sponsored beneficiaries. You can track your claims online and even receive e-mail alerts when a claim has been processed. trying to sign in to the site. NEA is an electronic attachment vendor. routine provider outreach to provide our consumers with the If an estimate is submitted with all the necessary information along with an approved NARF, when the actual considered "in-network". If total payments made by OCONUS Claims Submission Document. In cases where alternative methods of treatment exist, payment will be allowed for the least costly, professionally accepted treatment. How do I update my provider fee profile with MetLife? we will send a final, third letter providing another 10 days New 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. GHP's new Provider Care Team answers the call. understand the circumstances of the services you are requesting As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. is medically necessary or not. Negotiated fees refer to the fees that network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. submission as a prior pretreatment. Lexington, KY 40512. Accidental Annual Maximum Benefit Some clearinghouses and vendors charge a service fee. Box 3019 Where can I obtain an overview of a patient's dental benefits and coverage? The MetLife 2022 Federal Dental Plan Summary is available for viewing and printing at our website, MetLife.com/FEDVIP-Dental. information (name, phone number, state) on all requests for payment. Address activity that the industry is committed to pursuing and prosecuting. For all other plans, Also, please only pay the applicable cost share. 2018 MetLife Services and Solutions, LLC. P.O. Phone: 1-800-635-4238 What is dental insurance fraud? X-rays process. protect your data). insurance carriers? Infections at called "upcoding" For process Procedure codes for the treatment performed Patients with Command-sponsored enrollees have cost shares for 3 types of treatment: Other Restorative Services (i.e. Pleaseclick here to verify your patient's eligibility filed with the secondary plan. View a Sample ID Card. Street identification number, we ask that you accept and use it as the service and claims information. 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. MetLife will review and provide the patient with a summary of the covered costs. (1-877-638-3379) and requesting a Fast Fax patient plan benefit What do I need to do to verify or update my is not responsible for services provided by them. apply, and the member is responsible for the dentist's or orthodontist's fee in excess of MetLife's allowed fee. https://metdental.com? For more information on Materials not included in our TRICARE Dental Program Benefits Booklet. What is MetLife's Language Assistance Program? the attachments are sent to be archived. pretreatment estimate paid as actual claim) In situations where the natural parents are not married and there are two dental plans, MetLife considers the insurance plan of benefit information via this website or by calling 1-877-MET-DDS9 Your User name and and use it as the patients ID number in place of his/her SSN for all What are MetLife's guidelines regarding full-time displayed and the last choice on the drop-down box will be "About." a separate office bill is not needed, Non-Availability and Referral Form (NARF) for Orthodontia. What information am I required to verify/update? dental practice, and the alternative procedure for which an allowance is being paid must be a generally accepted alternative section of this website. transactions with MetLife. patients? according to the network guidelines? Detail or through our automated telephone service, 1-877-MET-DDS9 Choose the PO Box 14182 Chinese Claim Form Orthodontic care that was provided OCONUS will typically be paid in a lump sum. Tax Where is the plan limitations information? If you are servicing a member OCONUS, outside of the United States, alternate location. Disability. whole or in part, or that has had alternate benefit provisions We are a participating group and have a new dentist joining our group, how can we ensure that his/her claims are processed Where can I get a TRICARE Dental Program claim form? office information include the following information: educational institution. allowable charges)? according to TDP provisions and limitations. numbers for all transactions and through all MetLife systems, information such as provider name, practice location, contact Is there any additional information that would help Provider Identifiers (NPIs). Contact the clearinghouse for information. Original items secondary carrier exceed the dentist's charge. "January","February","March","April","May","June","July","August","September","October","November","December"); plan? If you're unhappy with the outcome of a processed claim, you can ask for the claim to be reconsidered for payment. generic materials that do not contain personalized information. How can I obtain a copy of a member's Schedule of Part of this effort requires that MetLife conduct Participating providers may obtain a copy of their applicable fee schedule by Some dental insurance policies only allow for teeth cleanings every six months. Fax Number: Phone Untimely filing. Spanish Claim Form We will then Office Information payment will not be changed to U.S. dollars. alternative number to use when transacting with MetLife. Lexington, KY reconsidered. However, Medicare timely filing limit is 365 days. questions you may have regarding the provider verification electronically through a claims clearinghouse or through paper and fax. As a participating dentist, can we charge our "normal" fee for a dental procedure that is not covered under a patient's dental of the letter. on this system or online, you will need to speak directly with a Customer Service Representative. and benefit matrixes (the Benefit Overview). You may notice, however, that some ID cards All others will pay cost-shares as shown in Section 4 of the TRICARE Dental Program Benefit Booklet. determine if the patient is eligible, and provide the requested services. Annuities. Why are claims for the employed dentists not being paid individually. Box 981282 suppressed from our directories until you complete this If necessary, commercial paper claims may be submitted as follows: Mail original claims to BCBSIL, P.O. If the service actually provided is not covered, If MetLife is unable to determine which What are MetLife's guidelines regarding full-time students? When the Plan member is traveling outside of their state of residence, submit all claims to: CIGNA Healthcare. To view current maximum information, access the Eligibility and Plan Detail - Enrolling in EFT is easier than you think. under one TIN, how can we ensure payments are processed under the percentages). However, the filing limit is extended another . Address Tax letterhead Metropolitan procedure codes submitted The TRICARE Dental Program Benefit Booklet is an essential guide to the TDP benefits. MetLife offers written translation services to all our plan participants. listed. provider information (name, phone number, state) on all requests for the CONUS Claims Submission Document. and the payment for the alternative service. Wrong provider What are some examples of dental insurance fraud? MetLife information that will be required on our provider please review Eligibility & Plan Detail to determine the type of MetDental.com, or you may mail the verification form to the If you submit claims Street The time it takes to process a claim depends on its - 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. How long will it take to process submitted dental interested in joining the program, you can request an enrollment package that describes the program and includes a sample fee schedule MetLife can fax plan design information to from the TDP enrollee. Lexington, KY 40512. coordination applied to the subscriber/employee's plan. which has been established by the National Association of Insurance Commissioners. Fee schedules are given to participating Ages may differ depending on certain 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 services other than Orthodontia, Each plan year begins May However, claims submitted electronically will typically flow when applicable to consider benefit payment as secondary insurance. must obtain these schedules directly from their employer (typically information? part of their dental benefits plan (as opposed to coinsurance 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 via the Human Resources dept.). any documentation required to adjudicate claims. If a patient indicates that they or their group is new to MetLife and you 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. X-rays sent in by dental offices. incorrect information. The time it takes to process a claim depends on its complexity. anesthesia will normally be allowed. 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. being handled within 14 calendar days. Program or if are already a program dentist. Submit claims to MetLife for new services provided to patients as you weeks.*. Information Currently on File Quick and easy access to MetLife customer support services and resources. for TDP dental benefits, however, they have different patient cost shares. Please follow the instructions per Where do I submit claims and requests for pretreatment estimates? claims. Before any orthodontic care, the TAO, overseas uniformed services dental treatment facility (ODTF), or designated OCONUS Points of estimate, What if I need to submit a Denied or alternatively these currencies through recognized U.S. banking institutions. Once your TIN and ZIP Code are recognized, you will be prompted to verify your Print instructions. at 1-800-462-6565. There are also some local union plans that have even . Treating dentists office information and his/her signature, Where do I submit treatment reports and utilizations? The amount of benefits payable by MetLife Name If the What is "NEA" and how can I participate? Box 3019 If submitting a claim to a clearinghouse, use the following payer IDs for Humana: Claims: 61101. You will need to New York, NY 10166 - All Rights Reserved. If our office has multiple dentists located and registered Simply have your dentist submit a request online or by phone. This list Password will be needed each time you sign in to the MetDental.com website. All providers who wish to participate in the Preferred Dentist Program For dental care provided in OCONUS locations, if the claim form to be submitted does not already provide the following information, authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist. 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. 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. service to process a payment. Levels, Frequency & Limitations" page for the specific ages of 19 and 23 if they are enrolled full-time at an approved The review on appeal will take into account all comments, documents, records, and other information that You submit relating to Your claim without regard to whether such information was submitted or considered in the initial determination. El Paso, TX 79998-0930 (If you wish to purchase a scanner on your own you should contact NEA directly through Tesia-PCI, Inc., or have Practice Management Software your files. MetLife dental plan is secondary, most coordination of benefits Dental PPO Network Development Address Provider The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law. These unique identification numbers Ages may differ depending on certain Date for this office Typically, ID cards are issued for to all subscribers. Please call 1-877-MET-DDS9 (1-877-638-3379) to obtain a Fast Fax. When applicable, Plan Maximum &Deductibles are available Or, call 1-877-MET-DDS9 (1-877-638-3379) // patched for y2k bug! according to network guidelines? This information is available on the Eligibility and Plan Detail page for your specific patient. orthodontist's services will be calculated based on the remaining orthodontic maximum. If MetLife denies Your claim, You may take two appeals of the initial determination. the exchange rate in effect on the last date of service listed on the claim or bill. provider. the date of service page for your specific patient. supplement to electronic claims, allowing a complete electronic following: En Espaol duty personnel, members of the Selected Reserve and Individual Ready Reserve, their eligible family members, and survivors. example: address, telephone number, or TIN? processing is expedited over standard mailing times Simply dial 1-877-MET-DDS9(1-877-638-3379), and select Option 1. To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of the Department approximately 3 days to schedule and is available for your California patients only. never leave the office How much will I pay when using a non-network provider? Summary page. The dentist and patient should decide which treatment to select. In order to receive OCONUS cost shares, beneficiaries must be Command Sponsored. MetLife and its Affiliates will mark the box by the Expand All. P.O. contracted as well to receive the benefits of participation and to be information is readily available on this website and through our The percentage covered is 50%. Inc. (NEA) to electronically transmit dental X-rays, EOBs, perio state laws or regulations now set forth required fields that All providers who wish to participate in the Preferred Dentist Program must apply for participation individually. All payments requiring conversion to foreign currency will be calculated based on Do MetLife PDP dental plans pay for general anesthesia Detail. educational institution. reduced due to the benefits paid under the primary plan. the date of service on the approved pretreatment estimate form or residence. open theLAP Notice of Name / Practice Name After the initial exam is completed, the initial NARF, the claim form, and the provider's bill for the initial exam and treatment Bridges and Dentures. However, in recently purchased from another dentist? MetLife does not normally issue ID cards for individuals covered under treatments. and the group practice owner is a participating Representative by clicking patient's dental plan? Please reference the member's Schedule of The timely filing limit varies by insurance company and typically ranges from 90 to 180 days. To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of Negotiated fees are subject to change. MetLife TRICARE Dental Program joining the program, you can request an enrollment package that var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); Currently, MetLife recommends that a request for pretreatment is submitted for *Some information that we have on file for you asking you to update nor will the government pay for any costs once the maximum has been met. Please note that these ID cards are not a guarantee of eligibility, After payment has been received from the primary plan, the claim can be General for your area. Performing work Government Programs Claims. You will need to identify the This example assumes youve already satisfied the annual deductible and your annual maximum benefit has not been met. The time period varies per insurance company and can be anywhere typically from 90 days to one year. This process takes approximately 4 weeks. To nominate your provider, visit metlife.com/mchcp/. Most claims flow through our system quickly and efficiently, with most Where can I get a dental claim form? However, ID cards are not required because eligibility and plan design 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. information, you may submit your questions to a Customer Response automated phone system. To submit a CONUS claim, please follow the instructions on Address*: confirm or update your information within 30 days of the date Please refer to the Subscriber's Schedule of Box 981282 El Paso, TX 79998-1282 SPECIAL INSTRUCTIONS FASTFAX BENEFIT SUMMARY* You may have seen recent news coverage of customers of financial services companies falling victim to social engineering scams. What can I do if I suspect dental insurance fraud? The birthday rule determines the first plan to There are several reasons for three failed attempts to enter your password. However, MetLife often needs additional information Duplicates should be dated These claims should be sent to: Whenever a spouse's or child's other plan is primarily a medical insurance plan, but includes a dental benefit, the plan is Number Now, you have fixed the problem and resubmitted it with the correct info, but the carrier . Most claims flow through our system quickly and National Electronic Attachments, Inc. (NEA) is used by dental provide plan participants and you an alternative number to use when document via fax. Check your patients plan design. the most recent available to you. Amount billed for each procedure (if applicable) Orthodontic care initiated in the CONUS service area may be continued OCONUS as long as the orthodontic lifetime maximum has not Doctors var monthNames = new Array( Family Care and Partnership waiver service providers who are unable to submit using one of the standard claims forms mentioned above are encouraged to submit using one of . If you are not a participating provider and are interested in (if any), hospital name, and state license number. which have not been paid by the primary plan. Learn how to get one now. Group Claim Review Effective already contracted, dentists who work for the primary owners must be of the Explanation of Benefits (EOB) Statement from the prior carrier Your total out-of-pocket cost would be $344. Don't forget to click the "Sign Out" button after you are finished using this site. Program individually. Participating providers may obtain a copy of their applicable fee schedule by calling MetLife's dedicated dental service line at 501 U.S. we offer interpreter services in over 170 languages and dialects. personal or business check for the amount incorrectly issued with a If you suspect Dental Insurance Fraud, call the MetLife Fraud Hotline Other forms of attachments could be The provider verification process is a routine provider please be sure to include: For MetLife to process claims, the following information is needed: How will claims be paid for OCONUS Beneficiaries?