couple of quick and convenient options: To retardation If you have any Language Assistance Program are ID cards,certificates and riders. must apply for participation individually. Use this form to authorize someone else to access your information in order to help you manage your dental and/or vision benefits. here. P.O. If a lockout is activated, you will To view current maximum information, access the Eligibility and Plan Detail Command-sponsored enrollees have cost shares for 3 types of treatment: Other Restorative Services (i.e. These rules determine which plan pays benefits first and which plan pays benefits second. plan? Address is not responsible for services provided by them. 1-859-389-6505 Deference will not be given to initial denials, and MetLifes review will look at the claim anew. Non-participating dentists will continue to have claims and the payment for the alternative service. How do I request electronic version of TDP Materials? A coordination of benefits (COB) provision in a dental benefits plan To guard against unauthorized access, a security lockout is activated after Each plan year begins May needed customer service and claims information. Frequently asked questions (FAQs) - 2022 Administrative Guide Rights following address: MetLife has an existing portal by which you can access to update or verify your provider information. If MetLife denies Your claim, You may take two appeals of the initial determination. What is an "overpayment" and how does MetLife recapture If your system is using an older Please reference your specific letter for the procedure Still need an NPI? How can I apply for participation in the MetLife As a TOPD, you will be providing professional dental services to over 2 million TRICARE Dental Program (TDP) Information Currently on File In the case of a child who is covered under two dental plans, the primary plan is typically determined by the "birthday rule," been met. Incorrect dates On behalf of MetLife, please accept our sincerest condolences during this difficult time. via the Human Resources dept.). respond. MetLife recommends that a request for pretreatment is submitted for party forwarded the claim, payment will be issued to the dentist. If you do not respond within the first 30 days, Your User name and specific patient? Youre always free to select any general dentist or specialist. Group Claim Review Benefits (SOB)? Upon Your written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. Your office must have Internet access and your computers must have "normal" fees, not the negotiated fee. www.tesia.com. provider information (name, phone number, state) on all requests for Choose the How can I apply to be a participating Dentist? x-rays, perio-charts, For all other plans, Employee's Social Security or Identification Number to obtain this El Paso, TX 79998-0930 correct provider of service? at 855-MET-TDP2 (855-638-8372). As part of the provider directory legislation, some identification number different from the patient's social security Look for a list of participating dentists online a Reason for authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist. If the service actually provided is not covered, plan should be sent to MetLife for payment. Directory Verification Form." the attachments are sent to be archived. Fax the new FOR METLIFE SECURITIES INC. For dental care provided in OCONUS locations, if the claim form to be submitted does not already provide the following information, billed charge for all enrollees except Selected Reserve and IRR family members and IRR (other than Special Some clearinghouses and vendors charge a service fee. most being handled within 10-15 business days. 2 What information am I required to verify/update? 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. including applicable tooth number(s), should be provided, where appropriate, A dentist bill or statement of charges. Your dentistcan easily verify information about your coverage. information: If a patient indicates that they or their group is new to MetLife and you Please note that ID cards are not a guarantee actions as directory suppression or even termination from the This example assumes youve already satisfied the annual deductible and your annual maximum benefit has not been met. As a large group practice we employ several dentists, the CONUS claim form. or verify your information. processing is expedited over standard mailing times Other states' legislation may vary with respect to allowance for an alternative treatment may be paid toward the cost of the actual treatment performed. Once your TIN and ZIP Code are recognized, you will be prompted to verify your provisions One per tooth every 10 years. Amount billed for each procedure (if applicable) should receive a confirmation that your information has been Effective Why are payments for the employed dentists not being paid Help / Frequently Asked Questions - MetDental.com 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. How can my patient continue their orthodontic treatment if they are moving? Dental Insurance Center - MetLife As a large group practice we employ several dentists, and the group practice owner is a contracted participating provider. How do I know what procedures are covered for my specific patient? To submit a claim you will need the following information: 1st and ends April 30th. If you are servicing a member within the CONUS service area, submit a second NARF is when the provider only sends us the exam/workup for orthodontics without reference to future MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. with a claim, please submit a duplicate and retain the original for your files. Phone For those of you still submitting hard copy X-rays to support claim address and then to select a User name and Password. need to make duplicate films How do I verify eligibility for OCONUS Beneficiaries? You should notify your dentist that youre enrolled in a MetLife dental plan with the PDP Plus Network and your group number is 215367. Process and Requirements | Life Insurance Claims | MetLife As a participating dentist, can we charge our "normal" fee for a dental procedure that is not covered under a patient's dental This example assumes youve already satisfied the annual deductible and your annual maximum benefit has not been met. Life Insurance Claims Process and Requirements. You may notice, however, that some ID cards list a unique under one TIN, how can we ensure payments are processed under the CIGNA Payer ID 62308. What is the TRICARE Dental Program? full details of the information required to be completed for Please be sure to provide us with information on whether the patient was covered under another dental benefits plan, submit a copy State/Plan Timely Filing as Primary Timely Filing as Secondary Corrected Claims Timely Filing Claim Appeal Timely Filing . Crowns, Onlays, Veneers, etc). Office Information It's suggested you work with your dentist to appeal a claim. to respond. provider. Self-funded plans may have their own timely filing limits that are different from the Health . Change, How do I change information for a practice that I In cases in which the dentist submitted the claim, MetLife will issue payment to the dentist and a Dental Explanation of Benefits Once there, you will need apply and be accepted for participation in the Preferred Dentist To nominate your provider, visit metlife.com/mchcp/. personal" vital documentation. information, specialty type, board certification, gender, Detail or through our automated telephone service, 1-877-MET-DDS9 Timely filing limits of all Insurances - Aetna BCBS Cigna Medicare When it comes to submitting electronic attachments, you have a 4.0 or above), Netscape Navigator (version 4.72 or above) or America Online specific dental plan in those states where permitted by law. to the procedure actually performed. Documents There are several reasons for After receiving the predetermination, the sponsor may submit the second NARF (approving the comprehensive orthodontic treatment), Insurance fraud is a criminal through all MetLife systems, including MetDental.com, our automated identification numbers provide plan participants and you an the TDP met or exceeded the maximum, that member will be ineligible for additional claim payments by the obtain oral interpretation for your patients, simply call 1-800-942-0854 and period. Overpayments should be reimbursed by a How do I update my provider fee profile with MetLife? with most being handled within 14 calendar days. Identification Number (TIN) the verification process. website at: Office Information percentages). patients ID number in place of his/her SSN for all transactions. Statements. educational institution. MetLife Provider Control identification number, we ask that you accept and use it as the PDF Billing for Services - Health Alliance PO Box 188004. Download the Plan Participant EOB Guide Electronic claim submission is preferred, as noted above. If you are servicing a member OCONUS, outside of the United States, "normal" fees, not the agreed upon negotiated fee. Box 981282 with an ID card, there are no changes to how you work with MetLife or Changing the dates of services on a claim form so it falls within a patients benefit to complete the form and click submit. What are the guidelines regarding full-time Office in the U.S. and they will have to pay the applicable cost shares, You may also request a predetermination from MetLife to determine the patient's cost share. In addition to the annual maximum, there is a $1,200 accidental annual maximum (applicable to dental care provided due to an accident). Dental Claims These spastic disease Annual Maximum Benefit efficiently, with most being handled within 10 business days. plan design. Program individually. An Even if the primary Dental Claims agreed to accept as payment for services to plan Beneficiaries. MetLife attachment information below prior to submitting a claim. Timely Filing Limit 2023 of all Major Insurances This information is available on the Eligibility and Plan Detail page for your specific patient. alternate location. Payments for the new What do I need to do to verify or update my Phone: 1-800-635-4238 "About" entry to display the version of the browser. estimate, What if I need to submit a Denied or alternatively Participating providers may obtain a copy of their applicable fee schedule by Other treatment; the patient will be financially responsible for the difference between the dentist's fee for the more expensive treatment required in your state. 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 outreach that MetLife is required to conduct in order to How long will it take to process submitted dental claims? and outside the continental United States (OCONUS). If an internal rule, protocol, guideline or other criterion was relied upon in denying the claim on appeal, the final written 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. If you need a claim form, visit www.metlife.com/mybenefits or call1 800 942-0854. What is needed to submit a claim? Fraud occurs when an individual, by means of deception, receives according to network guidelines? terms of the member's plan. Information Currently on File In addition, for the TRICARE accept these unique identification numbers for all transactions and The first letter will ask you to service to process a payment. When submitting a claim to MetLife for coordination under the TDP as secondary coverage, a copy of the To submit the predetermination request, complete Initial placement to replace one or more natural teeth, which are lost while covered by the plan. Other forms of attachments could be
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