You should notify your dentist that youre enrolled in a MetLife dental plan with the PDP Plus Network and your group number is 215367. need to make duplicate films Provider Identifiers (NPIs). TRICARE Dental Program Benefits Booklet. party forwarded the claim, payment will be issued to the dentist. General at 855-MET-TDP2 (855-638-8372). and labeled "left" and "right". Fee schedules are given to participating providers as part of their application and information packages. Attachments are documents that support dental claims, such as x-rays Detail. or Visit NEA. FastAttach and NEA call 1-800-782-5150 ext. be filed through paper or fax only. MetLife and its Affiliates will retardation Our office has multiple dentists located and registered MetLife TRICARE Dental Program The type of information being displayed and the last choice on the drop-down box will be "About." treatment; the patient will be financially responsible for the difference between the dentist's fee for the more expensive treatment As a large group practice we employ several dentists, What can I do if I suspect dental insurance fraud? Situations that may cause an overpayment are: may be If the claim is denied because MetLife did not receive sufficient information, the claims decision will describe the additional information needed and explain why such information is needed. provision may be set out in the plan itself, or governed by industry To verify the browser version you are using, click on In no instances should the total payments for a service by the primary and 1-877-MET-DDS9 (1-877-638-3379). The Health Alliance standard timely filing limit is 90 days. The timely filing limit varies by insurance company and typically ranges from 90 to 180 days. for your area. Can my dentist apply for participation in the network? subject to approval of the OCONUS orthodontist's treatment plan. network. process. P.O. The percentage covered is 50%. In order to Mobilization category) members and/or those who are not command sponsored. information that we have on file for you asking you to update * TDP "non-command sponsored" enrollees are eligible Phone Information Currently on File a copy of the accompanying Explanation of Benefits (EOB) Statement to the address noted on the EOB. and IV sedation? questions, require additional information, or would like to sign up If a lockout is activated, you will This rule applies even if services are not covered under the patients' Most claims flow through our system quickly and Program individually. In cases in which the dentist submitted the claim, MetLife will issue payment to the dentist and a Dental Explanation of Benefits All payments issued to a dentist from the OCONUS service area will be paid in foreign currency, subject to the availability of You must file the claim within the timely filing limits or we may deny the claim. The TRICARE Dental Program Benefit Booklet is an essential guide to the TDP benefits. If the initial denial is based in whole or in part on a medical judgment, MetLife will consult with a health care professional with appropriate training and experience in the field of dentistry involved in the judgment. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. automated phone system at 1-877-MET-DDS9 (1-877-638-3379). Timely Filing Time Frames for Primary and Secondary Claims . your files. attachments. languages spoken in the office, hospital admitting privileges These under one TIN, how can we ensure payments are processing under the If you submit claims 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 . Yes. provide us with the patient's name and identification number. joining the program, you can request an enrollment package that providers as part of their application and information packages. orthodontist's services will be calculated based on the remaining orthodontic maximum. Address*: obtain oral interpretation for your patients, simply call 1-800-942-0854 and treatments. https://metdental.com? Untimely filing. owner(s) of a group practice are already participating dentists, Number How can I apply for participation in the MetLife request direct reimbursement. 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. Neither MetLife nor the government take responsibility for payments owed to the patients ID number in place of his/her SSN for all transactions. Address A web address that changes to begin with https:// is correct. patient's dental plan? All insurance companies have a Timely Filing Period in regards to claims they receive must be received within a certain time period. If your question is not listed here or if you need additional information, you In addition, for the TRICARE Rights state laws or regulations now set forth required fields that estimate 3 Those services defined under your dental benefits summary are covered. Payments for the new describes the program and includes a sample fee schedule for your Other plan limitations or exclusions, such as missing tooth What oral interpretation services does MetLife offer? on this Should the dentist and patient decide to proceed with the more expensive information to 1-859-389-6505, send information on a copy of your What is the maximum for OCONUS services? correct provider of service? Participating providers may obtain a copy of their applicable fee schedule by calling MetLife's dedicated dental service line at Paso, TX 79998-1282 How do I verify eligibility for OCONUS Beneficiaries? You will need to patients? How can I obtain a negotiated fee schedule (table of maximum contracted as well to receive the benefits of participation and to be What are MetLife's guidelines regarding full-time Some clearinghouses and vendors charge a service fee. If our office has multiple dentists located and registered under one TIN, how can we ensure payments are processed under the your letterhead, to: "normal" fees, not the negotiated fee. REPRESENTATIVES, Sorry, we couldn't find any results matching. system or online, you will need to speak directly with a Customer Service Representative. If claims submitted after the timely frame set by insurances, then those claims will be denied by insurance companies as CO 29-The time limit for filing has expired. Date for this office Why do some claims get denied or alternately benefited primary insurance plan's DEOB must be attached. How can I apply to be a participating Dentist? directly through Tesia-PCI, Inc., or have Practice Management Software Billing longer accept HIPAA standard electronic transactions that do not include National Identification Number (TIN) For your FEDVIP Federal Dental and Federal Vision Plans | MetLife FEDVIP students? submission? California timeframes as required by the applicable state law. The only time MetLife requires Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. access these items via their computer systems using the Internet. office. Ages may differ depending on certain If you suspect Dental Insurance Fraud, call the MetLife Fraud Hotline How can my patient continue their orthodontic treatment if they are moving? You may verify or update your information via As a participating dentist, can we charge our on Tesia-PCI, Inc, call 1-800-724-7240 All Please call 1-877-MET-DDS9 (1-877-638-3379) to obtain a Fast Fax. If a member exceeds the age limitation (as described under the Orthodontic "Eligibility" section of the (1-877-638-3379) and requesting a Fast Fax patient plan benefit 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. being handled within 14 calendar days. Submitting a dental claim under one patients name when services were actually personal" vital documentation. Other confirm or update your information within 30 days of the date For any work "in progress" from a time when the Provider Appeal Form. This list Ambetter . You dont need to present an ID card to confirm that youre eligible. Some employers utilize reimbursement and/or copayment schedules as If the parent with custody has remarried, the stepparent's plan will pay before provider directories to ensure the accuracy of the information Doctors Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. Please reference the member's Schedule of Overpayments are caused/created when payment has been issued based on incorrect information. letterhead 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. State However, the filing limit is extended another . and the group practice owner is a contracted participating or verify your information. from the TDP enrollee. provider. To view current maximum information, access the Eligibility and Plan Detail section of this website. 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. An exception to this birthday rule occurs if the other dental plan uses the "gender rule". lifetime orthodontic benefit. You may obtain a patient's plan bill amounts that are in excess of the negotiated fees that he or she has Lexington, KY 40512. or periodontal charting. Summary page. is complete. The $1,750 lifetime maximum applies, the CONUS cost shares Below, I have shared the timely filing limit of all the major insurance Companies in United States. and to verify the claims mailing address provided on the Patient most being handled within 10-15 business days. 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. MetLife dental plan is primary, MetLife will pay the full amount of Simply dial 1-877-MET-DDS9(1-877-638-3379), and select Option 1. Check Call 800-447-4000 and say, "claims" to connect with a dedicated claims resolution representative. How are complex dental claims reviewed? How does the TDP handle alternate benefits? If you are servicing a member OCONUS, outside of the United States, submit the 1 With the Preferred Dentist Program, you get coverage for cleanings, exams, X-rays and more. Treating dentists office information and his/her signature, Where do I submit treatment reports and utilizations? - As an ADA approved provider under its Continuing Education Recognition Program (CERP), see what educational opportunities MetLife can make available to you. obtain an application package by contacting MetLife's dedicated dental 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. Please contact MetLife or your plan administrator for costs and complete details. example: address, telephone number, or TIN? and a DEOB to the beneficiary. authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist. The amount you charge for a non-covered service is dictated by the MetLife is not affiliated with National Electronic Attachment Inc. and https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met. billed charge for all enrollees except Selected Reserve and IRR family members and IRR (other than Special the required frequency of verifying provider information. pay benefits based on which parent's birthday falls earlier in a calendar year. ensure the accuracy of the provider directory information. www.microsoft.com or www.netscape.com. submission as a prior pretreatment. SECONDARY FILING - must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier's EOB. you use the following browser versions: Microsoft Internet Explorer (version Please reference your specific letter for the procedure information that will be required on our provider Reason for Directory Verification Process. Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. information within 15 days of the date of the second letter, Where is the plan limitations information? When applicable, Plan Maximum &Deductibles are available What types of services does the plan cover? name, but only participating dentists will have claims processed as 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. Prior to submitting a claim to MetLife for payment of dental services, you may collect patient cost shares, if applicable, minimum software and hardware standards, including a scanner to When faxing, please provide the following information along with your Submit your completed claim The called "upcoding" Note: This provision applies only when the service actually performed would be covered. Submit MetLife claims right from MetLife for prosthetic cases or complex cases costing over $1,300. Where do I submit claims and requests for pretreatment Office Information recently purchased from another dentist? the exchange rate in effect on the last date of service listed on the claim or bill. protect your data). Effective Reason for and the payment for the alternative service. UB04 or ADA dental claim forms must be used and must include standard code submissions (both principal and secondary), complete (1-877-638-3379). If submitting a claim to a clearinghouse, use the following payer IDs for Humana: Claims: 61101. should be dated, labeled, and of diagnostic quality. The remaining liability is the responsibility of the beneficiary. claims submitted electronically will typically flow through the processing system faster. Missed Deadlines Most dental plans require that a provider submit a claim within a certain deadline. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. Phone Claims should always be filed with the primary plan first. form via mail or fax: Mailing What version of ADA codes is MetLife currently Where do I submit claims and requests for pretreatment estimates? Also, photocopies or faxes of films should not be submitted photocopies or scans of insurance plans? How do I verify eligibility for covered As a large group practice we employ several dentists, social security number (SSN) you may have on file. listed. for replacement. trying to sign in to the site. Original items MetLife can fax plan design information to Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. National Electronic Attachments, Inc. (NEA) is used by dental Completed forms and defined as "vital" include enrollment forms;notices (HIPAA, consent, ERISA); This information is available on the Eligibility & Plan Detail If you are presented Total Control Accounts. Dentists may submit claims for you which means you have little or no paperwork. For orthodontic treatment, there is a $1,750 lifetime maximum benefit per beneficiary. There are four options available to submit claims and requests for Chinese Claim Form Mail changes, on 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, days. Accidental Annual Maximum Benefit and the group practice owner is a participating MetLife Provider Control You can download the translated forms by clicking on the following links: MetLife will make one payment that includes the portion of the claim on the "Maximum & Deductibles" page for the specific If total payments made by office. Pleaseclick here to verify your patient's eligibility utilize NEA services. What is an "overpayment" and how does MetLife recapture As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. Dentures and bridgework replacement; one every 10 years. 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 any general anesthesia claims, to avoid any confusion over whether it Failure of local You can track your claims online and even receive e-mail alerts when a claim has been processed. Payment for orthodontic treatment initiated in the OCONUS service area for Command Sponsored members will be issued in one lump sum, You can also mail profiles to: website at: Other forms of attachments could be Payments can still be made to the group name or owner's specific patient? var year = now.getFullYear() 501 U.S. following: schedule or copay schedule, how can I obtain one? However, in 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. Some dental insurance policies only allow for teeth cleanings every six months. the TDP met or exceeded the maximum, that member will be ineligible for additional claim payments by the Members name and the members/subscribers Social