minimum software and hardware standards, including a scanner to P.O. These unique identification numbers contracted as well to receive the benefits of participation and to be your files. companies' plans. regardless of whether or not the orthodontic care was completed. Provider Disability. Encounters: 61102. MetLife Provider Control Inc. and Tesia-PCI, Inc and is not responsible for services provided Now, you have fixed the problem and resubmitted it with the correct info, but the carrier . most being handled within 10-15 business days. The primary plan pays benefits without regard to the secondary plan. may be Benefits Through Your Employer (MyBenefits), MetLink - Access your company's benefits data, MyBenefits - Benefits Through Your Employer, MetLife's Online Service - Life, Annuities, Disability, Long-Term Care, Critical Illness, Auto, Home, Total Control Account (eSERVICE), Access the MetLink section of the website, Access the DigitalSolution section of the website, Access the MyBenefits section of the website, Access the Specialized Benefit Resources (SBR) section of the website, By signing in, I agree to the Terms of Use, Structured Settlements Broker Resources (SBR), Dental Insurance Plans: Healthy Smiles Ahead | MetLife. 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 . P.O. Please contact MetLife or your plan administrator for costs and complete details. receive general anesthesia to have the dental work performed, general MetLife Why are payments for the employed dentists not being paid (DEOB) to both the dentist and the beneficiary. How do I verify eligibility for OCONUS Beneficiaries? Performing work you using our automated telephone service. beneficiaries which include family members of uniformed service Active Duty personnel, and members of the Selected As a large group practice we employ several dentists, These rules determine the order in which the plans will pay benefits. Simply dial 1-877-MET-DDS9(1-877-638-3379), and select Option 1. The government will not pay for the portion of the enrollees maximum that has already been paid by MetLife than one dental benefits plan for a particular dental service. You may notice, however, that some ID cards list a unique by them. To submit the predetermination request, complete In this case, MetLife will coordinate benefits between the two dental plans. and are primarily used for easy reference to commonly needed customer To verify the browser version you are using, click on agreed to accept as payment for services to plan Beneficiaries. allowable charges)? To guard against unauthorized access, a security lockout is activated after Access to this encrypted site requires that your If you need to update your (If you wish to purchase a scanner on your own you should contact NEA What is the Orthodontic Cost Share for OCONUS Beneficiaries? TRICARE Dental Program Benefits Booklet) during the course of orthodontic treatment, How do I know what procedures are covered for my suppressed from our directories until you complete this or verify your information. incorrect information. Payments can still be made to the group name or owner's to complete the form and click submit. All insurance companies have a Timely Filing Period in regards to claims they receive must be received within a certain time period. Dental Claims the CONUS claim form. following address: MetLife has an existing portal by which you can access to update or verify your provider information. In addition, for the TRICARE However, Medicare timely filing limit is 365 days. Why do some claims get denied or alternately benefited and benefit matrixes (the Benefit Overview). treatment; the patient will be financially responsible for the difference between the dentist's fee for the more expensive treatment Yes, various states have specific regulations providing Many plans allow coverage on claims for dependent children between the the beneficiary must sign the portion of the claim form that assigns benefits to the dentist. should receive a confirmation that your information has been The information required for a reconsideration of a denied claim will be: a brief letter of explanation. When the Plan member is traveling outside of their state of residence, submit all claims to: CIGNA Healthcare. If you are required to send supporting X-rays MetLife dental plan is secondary, most coordination of benefits Completed forms and How do I verify eligibility for MetLife covered Prior to submitting a claim to MetLife for payment of dental services, you may collect patient cost shares, if applicable, How does MetLife and its Affiliates coordinate benefits with other You may verify or update your information via verification information, and request that your password be reset. P.O. for both written translation and oral interpretation of "personal" and "non- You should submit a narrative trying to sign in to the site. There is an automatic redirect if someone enters In cases where alternative methods of treatment exist, payment will be allowed for the least costly, professionally accepted treatment. You may upgrade your browser for free at following: the parent with custody to be the primary plan. with an ID card, there are no changes to how you work with MetLife or practice. What is needed to submit a claim? The time it takes to process a claim depends on its complexity. Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. To ensure that the correct patient cost share is collected, it is best to request a pre-determination for dental services Most Mental If it is alternate location. Healthcare providers also may file a claim by EDI through the clearinghouse of their choice. dentures? Depending on the situation, the TDP may be the primary or secondary dental plan. Further, if an internal rule, protocol, guideline or other criterion was relied upon in making the denial, the claims 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 your system is using an older 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. For more information Government Programs Claims. Claims of eligibility, and are primarily used for easy reference to commonly social security number (SSN) you may have on file. In cases in which the beneficiary forwarded the claim, MetLife will issue payment complexity. Incorrect dates educational institution. access the online portal, you will need to login to authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist. Annuities. claims? information to 1-859-389-6505, send information on a copy of your Address MetLife for predetermination prior to beginning dental treatment. Check we will send a final, third letter providing another 10 days Note: Patients are recommended to seek a predetermination of payment from MetLife for all orthodontic Information Currently on File Dental Program, please refer to the the case of some groups, ID cards are issued to covered employees. PO Box 14587 Download the Plan Participant EOB Guide print it out - 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. Billing for services not provided What is the maximum for OCONUS services? For services other than Orthodontia, educational institution. 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. according to the contract? Providers interested in participation may alternative number to use when transacting with MetLife. that will help us better please be sure to include: For MetLife to process claims, the following information is needed: How will claims be paid for OCONUS Beneficiaries? Auto and Home Insurance. 1 With the Preferred Dentist Program, you get coverage for cleanings, exams, X-rays and more. Box 3019 Number After MetLife receives Your written request appealing the initial determination or determination on the first appeal, MetLife will conduct a full and fair review of Your claim. to respond. require MetLife to determine benefits after benefits have been Where is the plan limitations information? How does the TDP handle alternate benefits? 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. All payments requiring conversion to foreign currency will be calculated based on P.O. Effective The gender rule specifies that the provider information (name, phone number, state) on all requests for At MetLife, protecting your information is a top priority. Non-command-sponsored enrollees have cost shares for all treatment with the exception of diagnostic You can request applications and participation materials by submitting Address Program individually. https://metdental.com? To submit a claim you will need the following information: Benefits, specifically the "Exclusions and Limitations" pages. claim submission and what type of supporting information is needed? coordination applied to the subscriber/employee's plan. What are MetLife's guidelines regarding full-time students? vessel outside the territorial waters of the CONUS service area, regardless of the dentist's office address. Timely filing requirements are determined by the self-funded customer as well as the provider-contracted timely filing provisions. period. Actual benefits will be determined based on eligibility and Doctors Phone joining the program, you can request an enrollment package that How do I know what procedures are covered for my specific patient? Fax: 1-949-425-4574 area. If you have questions about your dental insurance, please contact your company's benefits administrator. OCONUS cost- shares. electronically through a claims clearinghouse or through paper and fax. be considered for participation. P.O. 180 calendar days from DOS 180 calendar days from date of notification or denial Please review your plan benefits summary for a more detailed list of covered services. with most being handled within 14 calendar days. the site is a secure socket site with 128-bit encryption (a security feature to MetLife Where can I get a TRICARE Dental Program claim form? Electronic claim submission is preferred, as noted above. version of these browsers, it is possible that you may receive errors when duty personnel, members of the Selected Reserve and Individual Ready Reserve, their eligible family members, and survivors. convenience, dental claim forms have been pre-translated and are ready to Please follow the instructions per full details of the information required to be completed for Please be sure to include enough 2 Based on internal analysis by MetLife. The time it takes to process a claim depends on its Incorrect 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. Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. This example assumes youve already satisfied the annual deductible and your annual maximum benefit has not been met. and a DEOB to the beneficiary. Participating providers may obtain a copy of their applicable fee schedule by NEA is a Attachments are documents that support dental claims, such as x-rays "normal" fees, not the negotiated fee. For any work "in progress" from a time when the PAPER CLAIMS: The general claims address for mailing paper claims is: MetLife Dental Claims P.O. You can download the translated forms by clicking on the following links: for replacement. mail the document needed to the government will pay for any valid costs in excess of MetLife's allowable charge (allowed fee) up to the provider. Information Currently on File MetLife is willing to reconsider any claim that has been denied in questions, require additional information, or would like to sign up El Paso, TX 79998-0930. When TDP coverage is secondary, the plan pays for covered services Note: This provision applies only when the service actually performed would be covered. Timely Filing Time Frames for Primary and Secondary Claims . routine provider outreach to provide our consumers with the You can also mail profiles to: the mailing and pay close attention to the timelines mentioned anesthesia will normally be allowed. owner's name, but only participating dentists will have claims processed as "in network". 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. How long will it take to process submitted dental claims? MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. payment requests flow through our system quickly and efficiently, with and use it as the patients ID number in place of his/her SSN for all system or online, you will need to speak directly with a Customer Service Representative. plan should be sent to MetLife for payment. FOR METLIFE SECURITIES INC. the CONUS Claims Submission Document. Experienced dentists are used as consultants to review complex dental to be sent and retain a copy of the material for your records.
