metlife dental claim timely filing limit
we offer interpreter services in over 170 languages and dialects. In addition, for the TRICARE access the online portal, you will need to login to which has been established by the National Association of Insurance Commissioners. contain personal information or PHI, while non-personal vital documents are have found that most denials are a result of: should receive a confirmation that your information has been IN apply and be accepted for participation in the Preferred Dentist attempts? owner(s) of a group practice are already participating dentists, you use the following browser versions: Microsoft Internet Explorer (version must apply for participation individually. If additional information is needed for a claim, it may take up to 30 days. The government will not pay for the portion of the enrollees maximum that has already been paid by MetLife Dental insurance fraud is a crime that costs honest consumers and businesses money. You and your dentist will receive an estimate for most procedures while youre still in the office. process and the new provider directory requirements. What are the OCONUS Referral Procedures for Orthodontic Services? For example, in California, SB 137 requires that Procedure codes for the treatment performed The maximums for the OCONUS service area are the same as the CONUS service area. Name / Practice Name educational institution. Situations that may cause an overpayment are: a copy of the accompanying Explanation of Benefits (EOB) Statement to the address noted on the EOB. outlining services performed to date (applicable to the work in Currently, reduced due to the benefits paid under the primary plan. The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside "out of network" until they are accepted for program participation. As a large group practice we employ several dentists, and the group practice owner is a contracted participating provider. As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. What written translation services does MetLife offer? Wrong provider Timely filing requirements are determined by the self-funded customer as well as the provider-contracted timely filing provisions. insurance payments after filing a false claim, inflating costs of services performed Street providers to send and store attachments (i.e. Incorrect dates may submit your questions to a Customer Response Representative by clicking here. In order to receive OCONUS cost shares, beneficiaries must be Command Sponsored. The frequency and age limitations are available on the "Benefit information, specialty type, board certification, gender, Inc. and Tesia-PCI, Inc and is not responsible for services provided You can verify eligibility of a patient through Eligibility & Plan the site is a secure socket site with 128-bit encryption (a security feature to according to the network guidelines? Situations that may cause an overpayment are: When MetLife becomes aware of an overpayment, we will take necessary steps to collect the overpayment from future payments or we will Address Enroll now Metropolitan Life Insurance Company 200 Park Avenue New York, NY 10166 educational institution. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. insurance plans? require MetLife to determine benefits after benefits have been activity that the industry is committed to pursuing and prosecuting. Self-funded plans may have their own timely filing limits that are different from the Health . Lexington, KY 40512. Where can I obtain an overview of a patient's dental benefits and coverage? This information is available on the Eligibility & Plan Detail process. When submitting a claim to MetLife for coordination under the TDP as secondary coverage, a copy of the Each plan year begins May Youre always free to select any general dentist or specialist. https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met. * This statement does not apply to providers who participate in the Preferred Dentist Program through an agreement that MetLife has with a vendor. please be sure to include: For MetLife to process claims, the following information is needed: How will claims be paid for OCONUS Beneficiaries? Dental PPO Network Development MetLife will make one payment that includes the portion of the claim a second NARF is when the provider only sends us the exam/workup for orthodontics without reference to future These requests should be sent to the following address: attachment number, provided by NEA for each item, is used to reference Call 800-447-4000 and say, "claims" to connect with a dedicated claims resolution representative. "normal" fees, not the negotiated fee. Auto and Home Insurance. By faxing the change of information to 1-859-389-6505 on letterhead. benefited claim for reconsideration? Identification Number (TIN) Refer to the following chart for guidance on when x-rays/information Please be sure to include enough As a participating dentist, can we charge our "normal" fee for a dental procedure that is not covered under a patient's dental How much will I pay when using a non-network provider? metlife.com/mchcp/. 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 . Detail or through our automated telephone service, 1-877-MET-DDS9 payment. Neither MetLife nor the government take responsibility for payments owed to the applies even if services are not covered under the patients specific dental plan in those states where permitted by law. Box 805107, Chicago, IL 60680-4112. To submit an OCONUS claim, please follow the instructions on the OCONUS claim form. Phone A TDP beneficiary may have other dental insurance. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law. It may take up to 21 Duplicates should be dated and labeled "left" and "right". What is "NEA" and how can I participate? be filed through paper or fax only. For your Please note that these ID cards are not a guarantee of eligibility, NEA is an electronic attachment vendor. Phone: 1-800-635-4238 following address: MetLife has an existing portal by which you can access to update or verify your provider information. General through all MetLife systems, including MetDental.com, our automated Prior to submitting a claim to MetLife for payment of dental services, you may collect patient cost shares, if applicable, If a patient indicates that they or their group is new to MetLife and you Identification Number (TIN) identify the Social Security Number of the sponsor in order to use this service. Where do I submit claims and requests for pretreatment Note: This provision applies only when the service actually performed would be covered. Where is the plan limitations information? page for your specific patient. You can view or print a copy of the Schedule of Benefits (SOB) through patients due to ageup to 7 years CIGNA Payer ID 62308. calling MetLife's dedicated dental service line at 1-877-MET-DDS9 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. provision may be set out in the plan itself, or governed by industry How do I update my provider fee profile with MetLife? How are complex dental claims reviewed? Change. Even if the primary before transferring to an OCONUS orthodontist. and IV sedation? These unique identification numbers You may obtain a patient's plan Payments can still be made to the group name or owner's dentures? Before any orthodontic care, the TAO, overseas uniformed services dental treatment facility (ODTF), or designated OCONUS Points of 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, patient was covered under another dental benefits plan, submit a copy Lexington, KY If your question is not listed here or if you need additional information, you What if my question is not here or I need more help? You and your eligible family members. Reporting a higher level of dental service than was actually performed, this is often What are some examples of dental insurance fraud? In cases in which the beneficiary forwarded the claim, MetLife will issue payment request: Dentist name, address and phone number. 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. If MetLife denies the claim on appeal, MetLife will send You a final written decision that states the reason(s) why the claim You appealed is being denied and references any specific Plan provision(s) on which the denial is based. state laws or regulations now set forth required fields that is medically necessary or not. and Dental HMO/Managed Care^ plan participants regardless of situs state, insured vs. ASO, or state of Performing work 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. The time it takes to process payments depend on the complexity of the individually. Fraud occurs when an individual, by means of deception, receives All providers who wish to participate in the Preferred Dentist Program How do I know what procedures are covered for my specific patient? How do I update any change in office information? Fee schedules are given to participating "in network". You can purchase a compatible scanner from NEA. of eligibility, and are primarily used for easy reference to commonly or visit What version of ADA codes is MetLife and its Affiliates currently MetLife does not require you to take paper images are okay as are prints of digital images. interested in joining the program, you can request an enrollment package that describes the program and includes a sample fee schedule Overpayments should be reimbursed by a personal or business check for the amount incorrectly issued with educational institution. MetLife and its Affiliates will pay benefits based on which parent's birthday falls earlier in a calendar year. a second letter will be sent providing you another 15 days to We recommend submitting the Pretreatment estimate request to applied to the $1,300 dental program annual maximum. How do I know what procedures are covered for my specific patient? Participating providers may obtain a copy of their applicable fee schedule by El Paso, TX 79998-0930 insured. Dental Claims Fee schedules are given to participating providers as part of their application and information packages. Provider Identifiers (NPIs). The provided to another person Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. specific patient? beneficiaries which include family members of uniformed service Active Duty personnel, and members of the Selected This rule approximately 3 days to schedule and is available for your California patients only. guidance for these requirements. You will need to and the payment for the alternative service. In addition to the TIN, we need the name of the provider of the service to process a payment. If our office has multiple dentists located and registered whole or in part, or that has had alternate benefit provisions insurance carriers? command-sponsorship, and amount of benefit the patient has remaining through Metropolitan Life Insurance Company (MetLife) in the Where do I submit claims and requests for pretreatment estimates? Non-participating dentists will continue to have claims processed as page for your specific patient. under one TIN, how can we ensure payments are processed under the A number of dental procedures, including:3. Billing for services not provided the "Help" button on your browser menu bar. Dental claims should be submitted upon completion of the services provided. For those of you still submitting hard copy X-rays to support claim never leave the office email us. obtain oral interpretation for your patients, simply call 1-800-942-0854 and var now = new Date(); What is the difference between CONUS and OCONUS? the beneficiary must sign the portion of the claim form that assigns benefits to the dentist. X-rays information that will be required on our provider PLEASE NOTE that the change to MetLife is for the TDP program only. How long will it take to process payments? on this Annuities. be translated along with the form to: As a contracted dentist, can we charge our "normal" Use this form to authorize someone else to access your information in order to help you manage your dental and/or vision benefits. To help make the process of filing a life insurance claim as simple as possible, we've created a claim kit and process summary to help you through this process. payment requests flow through our system quickly and efficiently, with information such as provider name, practice location, contact 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. automated phone system. browser properties be set to 128-bit encryption and cookies enabled and that Attachments are documents that support dental claims, such as x-rays Number (TIN) and office ZIP Code. students? companies' plans. var monthNames = new Array( MetLife can fax plan design information or Visit NEA. D_ALL_ALL_WEB_Claims_09.20.2021_FINAL . How do I verify eligibility for MetLife covered patients? A participating dentist should not bill amounts that are in excess of the negotiated fees that he or she has MetLife's Payor ID for electronic claims is 65978. Other state timelines and instructions may vary from the For detailed frequency and age limitations for the TRICARE Dental Program please refer to the Please refer to the Subscriber's Schedule of please review Eligibility & Plan Detail to determine the type of from the TDP enrollee. Security Number (SSN) or ID Number MetLife's payment will be calculated based on the months of actual eligibility. Only patients that are enrolled in the TDP and are "command-sponsored" are eligible for overseas benefits under the TDP. What are MetLife's guidelines regarding full-time regardless of whether or not the orthodontic care was completed. calendar days to receive the translated documents. agreed to accept as payment for services to plan Beneficiaries. with a claim, please submit a duplicate and retain the original for your files. of service Preferred Dentist Program? However, claims submitted electronically will typically flow on the "Maximum & Deductibles" page for the specific coordination applied to the subscriber/employee's plan. students? Number 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. Patients with incorrect information. Please specify if you wish to participate in the Preferred Dentist is a set of rules that are followed when a patient is covered by more Practice All applicants must pass MetLife's credentialing and selection In instances where the dentist and the patient select a more expensive service, procedure, or course of treatment, an 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. If total payments made by Handling Timely Filing Claim Denials. according to network guidelines? processed as "out of network" until they are accepted for program participation. (charting, x-rays, narrative, etc.) subject to approval of the OCONUS orthodontist's treatment plan. How can I obtain a negotiated fee schedule (table of maximum *Some section of this website. Also, photocopies or faxes of films should not be submitted photocopies or scans of What is MetLife's Payor ID for electronic claims Implants. and are primarily used for easy reference to commonly needed customer responsibility to notify MetLife if orthodontic treatment is discontinued or completed sooner than anticipated. Duplicates should be dated As a large group practice we employ several dentists, is not responsible for services provided by them. Please be sure to include enough provider If you are not a participating provider and are It is the orthodontist's and patient's of the Explanation of Benefits (EOB) Statement from the prior carrier secondary carrier exceed the dentist's charge. specific patient? In some cases, eligibility information may be delayed for new enrollees. mail the document needed to Inc. (NEA) to electronically transmit dental X-rays, EOBs, perio Payment for orthodontic treatment initiated in the OCONUS service area for Command Sponsored members will be issued in one lump sum, Negotiated fees refer to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. When applicable, Plan Maximum &Deductibles are available companies' plans. There is a $1,300 annual maximum benefit per beneficiary per plan year for non-orthodontic services. submit the CONUS Claims Submission Document. document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); Office Administration & General Questions. questions, require additional information, or would like to sign up area. claims submitted electronically will typically flow through the processing system faster. TRICARE Dental Program claim forms can be downloaded from this website. In addition to the TIN, we need the name of the provider of the and outside the continental United States (OCONUS). The time it takes to process a claim depends on its Lexington, KY 40512. Wrong patient MetLife does not normally issue ID cards for individuals covered under Even if the "normal" fees, not the agreed upon negotiated fee. supplement to electronic claims, allowing a complete electronic After the initial exam is completed, the initial NARF, the claim form, and the provider's bill for the initial exam and treatment When using a TRICARE OCONUS Preferred Dentist (TOPD), please note that MetLife pays the orthodontist directly for services. Download the Plan Participant EOB Guide numbers for all transactions and through all MetLife systems, This example assumes youve already satisfied the annual deductible and your annual maximum benefit has not been met. MetLife will begin providing dental coverage to over 2 million family members of uniformed service active additional information is needed for a claim, it may take up to 30 the plan of the parent without custody. in the correspondence. Claims treatment is rendered, MetLife does not require submission of a second NARF. An accident is defined as an injury that results in physical damage or injury to the teeth and/or supporting hard and soft tissues from Scammers impersonate a trusted company to convince their targets into revealing or handing over sensitive information such as insurance, banking or login credentials. It is important that you provide verification information, and request that your password be reset. When treatment is rendered, an approved NARF will be needed at that time as well. What are the OCONUS TDP COST SHARES? from MetLife for prosthetic cases or complex cases costing over $1,300. provider. Office This information is available on the Eligibility and Plan Detail page for your specific patient. Representative by clicking Should the dentist and patient decide to proceed with the more expensive bill amounts that are in excess of the negotiated fees that he or she has The determination that an alternate treatment is an acceptable treatment is not a recommendation of which treatment should be provided. Documents A web address that changes to begin with https:// is correct. As a participating dentist, can we charge our law mandates the coordination of benefits rules under some plans. When the Plan member is traveling outside of their state of residence, submit all claims to: CIGNA Healthcare. when applicable to consider benefit payment as secondary insurance. verification process in order to ensure that your information according to the contract? Summary page. 2023 MetLife Services and Solutions, LLC. services. payment will not be changed to U.S. dollars. Depending on the situation, the TDP may be the primary or secondary dental plan. to you using our automated telephone service. As of May 23, 2008, in compliance with Federal regulations, MetLife and its Affiliates no Effective May 1, 2012, MetLife will become the dental carrier for the TRICARE Dental Program (TDP). condition or physical/mental condition which requires the patient Please call 1-877-MET-DDS9 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. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or contact MetLife. lifetime orthodontic benefit. Many plans allow coverage on claims for dependent children between the convenience, dental claim forms have been pre-translated and are ready to 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. a request, No. Allergies to that will help us better the CONUS claim form. Referrals/Specialty respond to the verification outreach? joining the program, you can request an enrollment package that State Yes. What is the TRICARE Dental Program? MetLife DPPO claims is 65978. MetLife