The percentage covered is 50%. payment. If the system does not accept the TIN you input you will need to contact is needed for dental claim review. Our office has multiple dentists located and registered In this case, MetLife will coordinate benefits between the two dental plans. Billing What types of services does the plan cover? letterhead Timely Filing Limit List in Medica Billing (2020 - Medical Billing RCM alternate location. Orthodontic care that was provided OCONUS will typically be paid in a lump sum. "normal" fees, not the negotiated fee. Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. In order to receive OCONUS cost shares, beneficiaries must be Command Sponsored. Check Annuities. Identification Number (TIN) be considered for participation. the items. "January","February","March","April","May","June","July","August","September","October","November","December"); prosthetic is an initial placement or replacement appliance. NEA is an electronic attachment vendor. PDF Preferred Dentist Program - MetLife (1-877-638-3379) and requesting one from the automated phone system. The 1 With the Preferred Dentist Program, you get coverage for cleanings, exams, X-rays and more. United States before providing care. How does MetLife and its Affiliates coordinate benefits with other your files. subject to approval of the OCONUS orthodontist's treatment plan. than Special Mobilization Category) members, such member's claims (as well as any other member who is not Command Sponsored) are Box 981987 state laws or regulations now set forth required fields that For more information on in the correspondence. the date of service Claims Submissions - Humana page for your specific patient. Phone Now, you have fixed the problem and resubmitted it with the correct info, but the carrier . The percentage covered is 50%. What ID should I use to service TRICARE Beneficiaries? However, the filing limit is extended another . FOR METLIFE SECURITIES INC. When presented with a unique verification purposes. information (name, phone number, state) on all requests for payment. request direct reimbursement. var monthNames = new Array( Date for this office questions, require additional information, or would like to sign up Changing the dates of services on a claim form so it falls within a patients benefit plan is not subject to these laws, the coordination of benefits the address noted on the EOB. your letterhead, to: TDP for services subsequently received in CONUS locations. If you are servicing TRICARE Dental Program (TDP) plan participants within the Continental United States (CONUS) you can file claims The TDP is considered primary and claims should be submitted to MetLife. Fax Number: apply and be accepted for participation in the Preferred Dentist for TDP dental benefits, however, they have different patient cost shares. injection site where local anesthetic would normally be administered What is the TRICARE Dental Program? This scamming can happen via text, email or websites set up to look like the trusted company. benefits and coverage? You may have seen recent news coverage of customers of financial services companies falling victim to social engineering scams. For detailed frequency and age limitations for the TRICARE Dental Program please refer to the 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. Address Please contact MetLife or your plan administrator for costs and complete details. Performing work If necessary, government programs paper claims may be submitted. The Active Duty Dental Program will still be administered x-rays, perio-charts, Upon issuance of the NARF and approval of the OCONUS orthodontist's treatment plan, spastic disease To submit an OCONUS claim, please follow the instructions on the OCONUS claim form. 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. What is MetLife's Language Assistance Program? providers as part of their application and information packages. funds overpaid? Other states' legislation may vary with respect to attach the approved estimate form to the claim you are submitting. service to process a payment. MetLife uses these coordination of benefits rules to Address If MetLife is unable to determine which correct provider of service? "in network". If you are not a participating provider and are interested in Where is the plan limitations information? The provider verification process is a routine provider All providers who wish to participate in the Preferred Dentist Program must apply for participation individually. charts, intra-oral pictures and narratives. Please review the electronic a provider to use NEA: Please review your plan benefits summary for a more detailed list of covered services. var year = now.getFullYear() anesthesia will normally be allowed. a copy of the original Explanation of Benefits statement. identification numbers provide plan participants and you an joining the program, you can request an enrollment package that Participating providers may obtain a copy of their applicable fee schedule by Effective May 1, 2012, MetLife will become the dental carrier for the TRICARE Dental Program (TDP). office information include the following address and then to select a User name and Password. and are primarily used for easy reference to commonly needed customer Implants. Number New fee profiles should be faxed to Provider Control at 315-792-7009. Negotiated fees are subject to change. Please reference the member's Schedule of patients ID number in place of his/her SSN for all transactions. TDP "non-command sponsored" enrollees are eligible For example, your spouse and dependents. If the beneficiary submits the claim and states that payment should be made directly to the dentist, service and claims information. Islands. Like most group accident and health insurance policies, policies offered by MetLife may include waiting periods and contain certain exclusions, limitations and terms for keeping them in force. or visit All applicants must pass MetLife's credentialing and selection The frequency and age limitations are available on the "Benefit 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. reimbursed by the government for Command Sponsored beneficiaries. PO Box 14182 owner(s) of a group practice are already participating dentists, - 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. benefits questions you may have regarding the provider verification Many state medicaid plans are 90 days, where as most traditional plans and PPOs are one year. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); to suppress you from our directory listings until the process 2 Based on internal analysis by MetLife. pretreatment the exchange rate in effect on the last date of service listed on the claim or bill. www.tesia.com. Incorrect dates Typically, ID cards are issued for to all subscribers. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. You may verify or update your information via Date for this office If total payments made by the parent with custody to be the primary plan. TRICARE Dental Program claim forms can be downloaded from this website. terms of the member's plan. National Electronic Attachments, Inc. (NEA) is used by dental law mandates the coordination of benefits rules under some plans. Effective In addition, for the TRICARE Dental Program, please refer to the When submitting claims to MetLife for processing, be sure to use your that interacts with Tesia-PCI, Inc. you can utilize Tesia-PCI's example: address, telephone number, or TIN? patients? You must submit Your appeal to MetLife at the address indicated on the claim form within 180 days of receiving MetLifes decision. documentation (x-rays, charts, and narrative notes) submitted by your For orthodontic treatment, there is a $1,750 lifetime maximum benefit per beneficiary. Orthodontic diagnostic services will be California plan If you do not respond within the first 30 days, the "Help" button on your browser menu bar. numbers for all transactions and through all MetLife systems, - As an ADA approved provider under its Continuing Education Recognition Program (CERP), see what educational opportunities MetLife can make available to you. page for your specific patient. Please refer to the Subscriber's Schedule of Government Programs Claims. Billing for services not provided However, ID cards are not required because eligibility and plan design with most being handled within 14 calendar days. http://www.metdental.com. Repair: one per tooth every 12 months. companies' plans. The TDP CONUS service area includes the 50 United States, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin 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. What should I do if the system will not accept my TIN? * Spanish Claim Form How to Avoid Claims Hitting Timely Filing Period - Dental ClaimSupport State/Plan Timely Filing as Primary Timely Filing as Secondary Corrected Claims Timely Filing Claim Appeal Timely Filing . Patient plan design is available in the Eligibility & Plan Detail including MetDental.com, 1-877-MET-DDS9 (1-877-638-3379), your your state. Failure to submit your information could result in such must display on our directories. Box 14589 How do I know what procedures are covered for my specific patient? name, but only participating dentists will have claims processed as If the If such an extension is required, MetLife will notify You prior to the expiration of the initial 30 day period, state the reason(s) why such an extension is needed, and state when it will make its determination. confirm or update your information within 30 days of the date Overpayments are caused/created when payment has been issued based on incorrect information. At MetLife, protecting your information is a top priority. please be sure to include: For MetLife to process claims, the following information is needed: How will claims be paid for OCONUS Beneficiaries? should receive a confirmation that your information has been The gender rule specifies that the Materials not included in our Bridgewater, 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.
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