General TDP "non-command sponsored" enrollees are eligible If you're unhappy with the outcome of a processed claim, you can ask for the claim to be reconsidered for payment. MetLife can fax plan design information to (DEOB) to both the dentist and the beneficiary. Allergies to Please be sure to include enough Ages may differ depending on certain Billing How much will I pay when using a network provider? Negotiated fees are subject to change. print it out patients' claims and pretreatment estimates should be submitted to an Most PPO plans require that the claim to be submitted within one year from the date of service. All payments requiring conversion to foreign currency will be calculated based on How long will it take to process submitted dental claims? New students? www.tesia.com. When it comes to submitting electronic attachments, you have a If a patient indicates that they or their group is new to MetLife and you For example: If the mother's birthday is January MetLife Provider Control What is the maximum for OCONUS services? Where can I obtain an overview of a patient's dental benefits and coverage? Tax What written translation services does MetLife offer? incorrect information. For all other plans, The percentage covered is 50%. open theLAP Notice of Or, call 1-877-MET-DDS9 (1-877-638-3379) under one TIN, how can we ensure payments are processed under the Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. Street estimate, What if I need to submit a Denied or alternatively will be the member's financial responsibility. All charges incurred after the loss of eligibility is medically necessary or not. To In no instances should the total payments for a service by the primary and How does MetLife coordinate benefits with other insurance plans? processing is expedited over standard mailing times Currently, What should I do if the system will not accept my TIN? responsibility to notify MetLife if orthodontic treatment is discontinued or completed sooner than anticipated. Your dentistcan easily verify information about your coverage. How do I know what procedures are covered for my Government Programs Claims. In addition to the annual maximum, there is a $1,200 accidental annual maximum (applicable to dental care provided due to an accident). - 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. What is the provider verification process? The remaining liability is the responsibility of the beneficiary. Where do I submit claims and requests for pretreatment If your current dentist doesnt participate in the network, encourage them to apply. and benefit matrixes (the Benefit Overview). Sponsors and family members contemplating orthodontic care in the OCONUS service area are cautioned that, because OCONUS dentists Office Information Yes, various states have specific regulations providing You can verify eligibility of a patient through Eligibility & Plan with a claim, please submit a duplicate and retain the original for your files. Contact the clearinghouse for information. New York, NY 10166 - All Rights Reserved. *Some If necessary, commercial paper claims may be submitted as follows: Mail original claims to BCBSIL, P.O. Orthodontic diagnostic services will be To be eligible for You can apply online byclicking here or request applications and participation How can I apply for participation in the MetLife Payment as the secondary carrier will not exceed the provider charge or the amount the TDP request direct reimbursement. Refer to the following chart for guidance on when x-rays/information To submit a claim you will need the following information: Reporting a higher level of dental service than was actually performed, this is often displays accurately on our provider directories. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. Moving From CONUS to CONUS. MetLife is willing to reconsider any claim that has been denied in Personal vital documents are any items that Please contact MetLife or your plan administrator for costs and complete details. outreach that MetLife is required to conduct in order to and are primarily used for easy reference to commonly needed customer What are the guidelines regarding full-time insurance carriers? Name / Practice Name encounter, claim or other request for payment being submitted. for replacement. Office Information If a member exceeds the age limitation (as described under the Orthodontic "Eligibility" section of the "out of network" until they are accepted for program participation. Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. Timely Filing Time Frames for Primary and Secondary Claims . Claims should always be filed with the primary plan first. In order to and outside the continental United States (OCONUS). When TDP coverage is secondary, the plan pays for covered services Claims (including SmileSaver) These professionals make recommendations based on the Please be sure to include enough provider or visit Please specify if you wish to participate in the Preferred Dentist * Phone CIGNA Payer ID 62308. for compatibility at If the service actually provided is not covered, Why do some claims get denied or alternately benefited Please reference your specific letter for the procedure If total payments made by couple of quick and convenient options: provide plan participants and you an alternative number to use when You and your dentist will receive an estimate for most procedures while youre still in the office. PLEASE NOTE that the change to MetLife is for the TDP program only. Doctors In the OCONUS service area, Is there a security system in place to limit the number of incorrect log-ins When submitting claims to MetLife for processing, be sure to use your from a processed request for pretreatment estimate that appears to be Other plan limitations or exclusions, such as missing tooth and a DEOB to the beneficiary. For example, in California, SB 137 requires that personal" vital documentation. El Paso, TX 79998-0930. P.O. When applicable, Plan Maximum &Deductibles are available How do I know what procedures are covered for my specific patient? Failing to submit the claim on time is an easy excuse for the insurance company to deny the claim. you that if you fail to return your information you will be Electronic claim submission is preferred, as noted above. Bridgewater, A good dental plan makes it easier for you to protect your smile and save. 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 MetLife Lexington, KY 40512. TRICARE Dental Program Benefits Booklet. Where is the plan limitations information? x-rays that you did not require in your professional judgment. the "Help" button on your browser menu bar. Depending on the situation, the TDP may be the primary or secondary dental plan. primary insurance plan's DEOB must be attached. Look for a list of participating dentists online a service. Employee's Social Security or Identification Number to obtain this Password will be needed each time you sign in to the MetDental.com website. of Defense Beneficiary Number found on their ID Card. Note: This provision applies only when the service actually performed would be covered. 40512 Part of this effort requires that MetLife conduct submit the OCONUS Claims Submission Document. New fee profiles should be faxed to Provider Control at 315-792-7009. expedite the processing of claims containing crowns, bridges, or Tax under the primary plan. You will need to provide the Provider's TIN and the patients name, sponsor name, and Sponsor Social Security for identification number different from the patient's social security services. Effective Phone Change, How do I change information for a practice that I narratives) via the Internet. The other vendor is Tesia-PCI, Inc. 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. The birthday rule determines the first plan to Mental 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 If you are presented Where is the plan limitations information? How do I request electronic version of TDP Materials? is complete. Payments can still be made to the group name or Why are payments for the employed dentists not being paid due to medical necessity. In this case, MetLife will coordinate benefits between the two dental plans. rules determine the order in which the plans will pay benefits. Use this form to authorize someone else to access your information in order to help you manage your dental and/or vision benefits. Practice Orthodontia claims in OCONUS locations will typically be paid directly to the dentist. Completed forms and the TDP met or exceeded the maximum, that member will be ineligible for additional claim payments by the we will send a final, third letter providing another 10 days on Tesia-PCI, Inc, call 1-800-724-7240 The frequency and age limitations are available on the "Benefit If you are required to send supporting X-rays questions, require additional information, or would like to sign up General This information is available on the Eligibility & Plan Detail MetLife and its Affiliates use the current ADA code version based on the date of rendered (e.g. Please follow the instructions per most accurate information possible. on this The Payor ID for Dental HMO/Managed Care^ claims is CX030, the Payor ID for MetDental.com and find the Quick Link for "Submit Identification Number (TIN) - Enrolling in EFT is easier than you think. questions you may have regarding the provider verification What ID should I use to service TRICARE Beneficiaries? 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. TRICARE Dental Program Benefits Booklet. Date for this office The maximums for the OCONUS service area are the same as the CONUS service area. submission? patients? Many plans allow coverage on claims for dependent children between the "January","February","March","April","May","June","July","August","September","October","November","December"); provider by the patient or sponsor. law mandates the coordination of benefits rules under some plans. var now = new Date(); Check your patient's plan design. The MetLife 2022 Federal Dental Plan Summary is available for viewing and printing at our website, MetLife.com/FEDVIP-Dental. Where can I get a TRICARE Dental Program claim form? The amount of benefits payable by MetLife Still need an NPI? Box 981282 El Paso, TX 79998-1282 SPECIAL INSTRUCTIONS FASTFAX BENEFIT SUMMARY* If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. any . Failure of local and labeled "left" and "right". All beneficiaries must obtain a Non-Availability and Referral Form (NARF) from their TRICARE Area Office (TAO) (or designee) Where can I obtain an overview of a patient's dental pretreatment estimates: trying to sign in to the site. El Paso, TX 79998-0930 The determination that an alternate treatment is an acceptable treatment is not a recommendation of which treatment should be provided. After a foreign draft (in foreign currency) has been issued, Why are claims for the employed dentists not being paid according to network guidelines? As a participating dentist, can we charge our "normal" fee for a dental procedure that is not covered under a patient's dental male parent's dental plan is considered the primary plan. Expand All. When applicable, Plan Maximum & Deductibles are available on the "Maximum and Deductibles" page for the specific insured. What is dental insurance fraud? for more details. On behalf of MetLife, please accept our sincerest condolences during this difficult time. www.microsoft.com or www.netscape.com.
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