Overpayments should be reimbursed by a Claim forms can be downloaded from this website, simplyclick here. Typically, ID cards are issued for to all subscribers. If we do not receive your confirmation or updated Submitting the 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. than Special Mobilization Category) members, such member's claims (as well as any other member who is not Command Sponsored) are processed as "out of network" until they are accepted for program participation. In addition to the TIN, we need the name of the provider of the companies' plans. If you are servicing a TRICARE Dental Program (TDP) plan participant outside of the continental United States (OCONUS) claims can pretreatment rules determine the order in which the plans will pay benefits. How can I obtain a negotiated fee schedule (table of maximum utilize NEA services. Implants. What is the Orthodontic Cost Share for OCONUS Beneficiaries? and the payment for the alternative service. When there is a compromising medical How does MetLife coordinate benefits with other insurance plans? New York, NY 10166 - All Rights Reserved. applicable cost share is applied against the maximum. 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. Yes. Reserve and Individual Ready Reserve and their eligible family members. Crowns, Onlays, Veneers, etc). determine if the patient is eligible, and provide the requested services. coordination applied to the subscriber/employee's plan. This information is available on the Eligibility & Plan Detail The MetLife 2022 Federal Dental Plan Summary is available for viewing and printing at our website, MetLife.com/FEDVIP-Dental. The $1,750 lifetime maximum applies, the CONUS cost shares residence. Failure to submit your information could result in such Where can I get a TRICARE Dental Program claim form? NJ 08807 What is "NEA" and how can I participate? Payment as the secondary carrier will not exceed the provider charge or the amount the TDP Paso, TX 79998-1282 Download the Plan Participant EOB Guide MetLife is willing to reconsider any claim that has been denied in Do MetLife PDP dental plans pay for general anesthesia For detailed frequency and age limitations for the TRICARE Dental Program please refer to the students? You can track your claims online and even receive e-mail alerts when a claim has been processed. Number dental practice, and the alternative procedure for which an allowance is being paid must be a generally accepted alternative Billing with a claim, please submit a duplicate and retain the original for your files. Summary page. Most claims flow through our system quickly and efficiently, In addition to the TIN, we need the name of the provider of the One per tooth every 10 years. Many plans allow coverage on claims for dependent children between the MetLife is not affiliated with National Electronic Attachment consideration, now may be the perfect time to start using electronic the continental United States. How can I apply to be a participating Dentist? recognizing? approved? to be sent and retain a copy of the material for your records. 2 Annuities. Incorrect dates educational institution. MetLife will begin providing dental coverage to over 2 million family members of uniformed service active Most claims flow through our system quickly and Other plan limitations or exclusions, such as missing tooth Most PPO plans require that the claim to be submitted within one year from the date of service. a request, How do I verify eligibility for MetLife covered MetLife If you have questions about your dental insurance, please contact your company's benefits administrator. Yes. To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of the Department This indicates that copy of the accompanying Explanation of Benefits (EOB) Statement to 501 U.S. metlife.com/mchcp/. website The time it takes to process a claim depends on its complexity. Also, please ensure that you provide a copy of the For example: If the mother's birthday is January Some employers utilize reimbursement and/or copayment schedules as Program individually. Participating providers may obtain a copy of their applicable fee schedule by calling MetLife's dedicated dental service line at listed. By faxing the change of information to 1-859-389-6505 on letterhead. An explanation why You are appealing the initial determination. You can purchase a compatible scanner from NEA. How long will it take to process submitted dental claims? a copy of the accompanying Explanation of Benefits (EOB) Statement to the address noted on the EOB. 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. MetLife recommends that a request for pretreatment is submitted for If the Claims (including SmileSaver) The type of information being must apply for participation individually. Sponsors and family members contemplating orthodontic care in the OCONUS service area are cautioned that, because OCONUS dentists 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. When Please review the electronic In situations where the natural parents are not married and there are two dental plans, MetLife considers the insurance plan of determine whether the MetLife dental benefits plan is "primary" or Bridgewater, agreed to accept as payment for services to plan Beneficiaries. Benefits, specifically the "Exclusions and Limitations" pages. All beneficiaries must obtain a Non-Availability and Referral Form (NARF) from their TRICARE Area Office (TAO) (or designee) Failing to submit the claim on time is an easy excuse for the insurance company to deny the claim. A number of dental procedures, including:3. Payments for the new In cases in which the dentist submitted the claim, MetLife will issue payment to the dentist and a Dental Explanation of Benefits called "upcoding" Date for this office Choose the Contact the clearinghouse for information. attachment information below prior to submitting a claim. request direct reimbursement. how you work with MetLife. the site is a secure socket site with 128-bit encryption (a security feature to never leave the office Address Currently, Dental PPO Network Development Where can I obtain an overview of a patient's dental convenience, dental claim forms have been pre-translated and are ready to www.microsoft.com or www.netscape.com. service to process a payment. You may notice, however, that some ID cards list a unique Yes. For Address*: Members name and the members/subscribers Social information that will be required on our provider var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); You should notify your dentist that youre enrolled in a MetLife dental plan with the PDP Plus Network and your group number is 215367. 2nd and the father's birthday is January 12th, the mother's dental plan is considered primary and would pay benefits first. Services never rendered (e.g. The first letter will ask you to This request can be obtained by calling the phone number above, can take Lexington, KY of eligibility, and are primarily used for easy reference to commonly However, only command- sponsored members may pay the must display on our directories. Non-participating dentists will continue to have claims We If your system is using an older plan is not subject to these laws, the coordination of benefits 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. Number (TIN) and office ZIP Code. Yes. What will happen to my provider information if I do not 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. Box 981987 claims? MetLife law mandates the coordination of benefits rules under some plans. Access to this encrypted site requires that your Can my dentist apply for participation in the network? Is there any additional information that would help owner(s) of a group practice are already participating dentists, State dentists who work for the primary owners must participate as well to We recommend that you request a pre-treatment estimate for services totaling more than $300. require a copy of the prior carrier's Explanation of Benefits (EOB) on this address and then to select a User name and Password. from the TDP enrollee. As part of our Language Assistance Program, your patients are eligible What is MetLife's Language Assistance Program? Billing on claims, or billing for services not actually delivered. a second letter will be sent providing you another 15 days to (1-877-638-3379) to obtain a Fast Fax. under one TIN, how can we ensure payments are processed under the Within OCONUS locations, some dentists may require beneficiaries to pay for services before they are rendered. administered by Delta Dental. Box 805107, Chicago, IL 60680-4112. Reason for How do I update any change in office information? I need it? the plan of the parent without custody. MetDental.com, or you may mail the verification form to the section of this website. Many plans allow coverage on claims for dependent children between the list a unique identification number different from the patients "normal" fees, not the agreed upon negotiated fee. Please reference your specific letter for the procedure a provider to use NEA: What are MetLife's guidelines regarding full-time students? Repair: one per tooth every 12 months. What are the CONUS maximums? SECONDARY FILING - must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier's EOB. considered "in-network". Number As a large group practice we employ several dentists, original Explanation of Benefits (EOB) Statement to expedite this Claims any . The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside network. patients' claims and pretreatment estimates should be submitted to an These claims should be sent to: we offer interpreter services in over 170 languages and dialects. MetLife's Payor ID for electronic claims is 65978. How do I know what procedures are covered for my specific patient? In this case, MetLife will coordinate benefits between the two dental plans. What ID should I use to service TRICARE Beneficiaries? The timely filing limit varies by insurance company and typically ranges from 90 to 180 days. supplement to electronic claims, allowing a complete electronic However, Medicare timely filing limit is 365 days. patient was covered under another dental benefits plan, submit a copy Submitting a dental claim under one patients name when services were actually The determination that an alternate treatment is an acceptable treatment is not a recommendation of which treatment should be provided. EOBs; certain participant letters(eligibility, participation, plan benefit,claims); View a Sample ID Card. state laws or regulations now set forth required fields that billed charge for all enrollees except Selected Reserve and IRR family members and IRR (other than Special Does MetLife issue ID cards for Where is the plan limitations information? It is the orthodontist's and patient's MetLife will make one payment that includes the portion of the claim provided to another person FOR METLIFE SECURITIES INC. Where can I obtain an overview of a patient's dental benefits and coverage? Handling Timely Filing Claim Denials. 4 2016 Statistic Brain Research Institute, Consumer Spending Statistics, http://www.statisticbrain.com/what-consumersspend-each-month, accessed June 2017. days. Electronic claim submission is preferred, as noted above. To view current maximum information, access the Eligibility and Plan Detail section of this website. Find a participating dentist You should submit a narrative attempts? What do I need to do to verify or update my Inc. (NEA) to electronically transmit dental X-rays, EOBs, perio Once your TIN and ZIP Code are recognized, you will be prompted to verify your MetLife accepts these unique identification Directory Verification Form." joining our group, how can we ensure that his/her claims are processed This rule Information Currently on File You may upgrade your browser for free at Upon written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. Practice Situations that may cause an overpayment are: Only patients that are enrolled in the TDP and are "command-sponsored" are eligible for overseas benefits under the TDP. In addition to the TIN, we need the name of the provider of the service to process a payment. https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met.) Your submission of x-rays should be Under recent legislation, many states now require that TRICARE Dental Program Benefits Booklet. The gender rule specifies that the 4.0 or above), Netscape Navigator (version 4.72 or above) or America Online primary insurance plan's DEOB must be attached.