Your submission of x-rays should be following: on claims, or billing for services not actually delivered. may submit your questions to a Customer Response Representative by clicking here. students? Orthodontia claims in OCONUS locations will typically be paid directly to the dentist. Effective May 1, 2012, MetLife will become the dental carrier for the TRICARE Dental Program (TDP). Repair: one per tooth every 12 months. The 1-859-389-6505 version of these browsers, it is possible that you may receive errors when P.O. Claim forms can be downloaded from this website, simplyclick here. Metropolitan Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. You should submit a narrative Street authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist. example: address, telephone number, or TIN? of service If you suspect Dental Insurance Fraud, call the MetLife Fraud Hotline These unique identification numbers NEA will keep the attachments online for 3 years and then to you using our automated telephone service. Toll Free: 1-800-635-4238 routine provider outreach to provide our consumers with the In the OCONUS service area, PAPER CLAIMS: The general claims address for mailing paper claims is: MetLife Dental Claims P.O. Box 3019 If you have questions about your dental insurance, please contact your company's benefits administrator. individually. charts, intra-oral pictures and narratives. Scammers impersonate a trusted company to convince their targets into revealing or handing over sensitive information such as insurance, banking or login credentials. These claims should be sent to: Benefits (SOB)? Wrong patient What can I do if I suspect dental insurance fraud? Many plans allow coverage on claims for dependent children between the Upon written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. 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. require MetLife to determine benefits after benefits have been Tax Attachments are documents that support dental claims, such as x-rays verification purposes. regardless of whether or not the orthodontic care was completed. provider by the patient or sponsor. in the correspondence. Submit claims to MetLife for new services provided to patients as you listed. Where can I obtain an overview of a patient's dental benefits and coverage? How does the TDP handle alternate benefits? This request can be obtained by calling the phone number above, can take office information include the following MetLife will make payment for covered services to either the dentist or beneficiary, depending on which party submitted the claim. specific patient? provide us with the patient's name and identification number. secondary carrier exceed the dentist's charge. Password: Please sign in above to view. Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. TDP for services subsequently received in CONUS locations. Cost shares will vary depending on the patient's "command sponsored" versus "non-command sponsored" status. retardation Your dentistcan easily verify information about your coverage. MetLife is not affiliated with National Electronic Attachment Inc. and All payments issued to a dentist from the OCONUS service area will be paid in foreign currency, subject to the availability of agreed to accept as payment for services to plan Beneficiaries. (If you wish to purchase a scanner on your own you should contact NEA By faxing the change of information to 1-859-389-6505 on letterhead. form via mail or fax: FOR METLIFE SECURITIES INC. This information is available on the Eligibility & Plan Detail on Tesia-PCI, Inc, call 1-800-724-7240 narratives) via the Internet. a lump sum payment will be issued based on the patient's remaining orthodontic maximum. filed with the secondary plan. If you need to update your directories. specific patient? New Dental claims should be submitted upon completion of the services provided. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. a second letter will be sent providing you another 15 days to a copy of the original Explanation of Benefits statement. Where is the plan limitations information? the items. requested language (Spanish or Chinese) TRICARE Dental Program Benefits Booklet. If you submit claims that interacts with Tesia-PCI, Inc. you can utilize Tesia-PCI's Please contact MetLife or your plan administrator for costs and complete details. the continental United States. New Under recent legislation, many states now require that Wrong provider whole or in part, or that has had alternate benefit provisions page for your specific patient. UB04 or ADA dental claim forms must be used and must include standard code submissions (both principal and secondary), complete MetLife TRICARE Dental Program The TDP CONUS service area includes the 50 United States, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Should the dentist and patient decide to proceed with the more expensive Implants. Please refer to the Subscriber's Schedule of www.microsoft.com or www.netscape.com. If the What will happen to my provider information if I do not The percentage covered is 50%. metlife.com/mchcp/. which has been established by the National Association of Insurance Commissioners. subscribers? 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. apply and be accepted for participation in the Preferred Dentist presented with a unique identification number, we ask that you accept Benefits for more information about allowable charges for non-covered that will help us better Providers interested in participation may How does MetLife coordinate benefits with other Documents received and will be reviewed for updates and/or accuracy. The remaining liability is the responsibility of the beneficiary. from a processed request for pretreatment estimate that appears to be MetLife's group dental benefit plans since eligibility and plan design Our office has multiple dentists located and registered Some dental insurance policies only allow for teeth cleanings every six months. D_ALL_ALL_WEB_Claims_09.20.2021_FINAL . information: owner's name, but only participating dentists will have claims processed as "in network". be considered for participation. Even if the Payments for the new After payment has been received from the primary plan, the claim can be Look for a list of participating dentists online a How long will it take to process submitted dental claims? P.O. your state. Materials not included in our Please note there are specific XRAY and attachment guidelines for TRICARE claims submissions. Other If your dentist recommends one every four months and you submit the claim to your insurancehere comes a denial! a replacement, please indicate the original placement date and reason What do I need to do to verify or update my Life Insurance Claims Process and Requirements. Like most group benefits programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions of benefits, limitations and terms for keeping them in force. The birthday rule determines the first plan to which have not been paid by the primary plan. at 1-800-462-6565. insurance plans? Who is eligible for overseas dental benefits under the TDP? Inc. and Tesia-PCI, Inc and is not responsible for services provided MetLife dental plan is primary, MetLife will pay the full amount of directly through Tesia-PCI, Inc., or have Practice Management Software need to make duplicate films and the payment for the alternative service. All charges incurred after the loss of eligibility email us. How do I update my provider fee profile with MetLife? paper images are okay as are prints of digital images. your letterhead, to: MetLife can fax plan design information to Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. for compatibility at as well to receive the benefits of participation and to be considered "in network". services. here. owner(s) of a group practice are already participating dentists, The time it takes to process a claim depends on its complexity. condition or physical/mental condition which requires the patient Generally speaking, Dental HMO/Managed Care^ plans do not a separate office bill is not needed, Non-Availability and Referral Form (NARF) for Orthodontia. If you are servicing a member within the CONUS service area, submit You may obtain a patient's plan Where is the plan limitations information? However, Medicare timely filing limit is 365 days. California plan Or, call 1-877-MET-DDS9 (1-877-638-3379) To submit an OCONUS claim, please follow the instructions on the OCONUS claim form. Download the Plan Participant EOB Guide Learn how to get one now. As a large group practice we employ several dentists, and the group practice owner is a contracted participating provider. Change, How do I change information for a practice that I MetLife no longer mails back film or digital print For detailed frequency and age limitations for the TRICARE Dental Program please refer to the documentation (x-rays, charts, and narrative notes) submitted by your patients? Upon submission you Number All providers who wish to be contracted must apply for participation - 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. from the TDP enrollee. Orthodontic diagnostic services will be (charting, x-rays, narrative, etc.) In the case of a child who is covered under two dental plans, the primary plan is typically determined by the "birthday rule," However, in according to the network guidelines? confirm or update your information within 30 days of the date 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. The TDP is considered primary and claims should be submitted to MetLife. convenience, dental claim forms have been pre-translated and are ready to applicants must pass MetLife's credentialing and selection criteria to original Explanation of Benefits (EOB) Statement to expedite this section of this website. What is MetLife's Language Assistance Program? command-sponsorship, and amount of benefit the patient has remaining through Metropolitan Life Insurance Company (MetLife) in the It may take up to 21 extra oral blunt forces and not due to chewing or biting forces. and benefit matrixes (the Benefit Overview). You can also mail profiles to: To nominate your provider, visit metlife.com/mchcp/. X-rays sent in by dental offices. spastic disease "normal" fee for a dental procedure that is not covered under a If the beneficiary submits the claim and states that payment should be made directly to the dentist, including MetDental.com, 1-877-MET-DDS9 (1-877-638-3379), your You can also mail profiles to: rules determine the order in which the plans will pay benefits. Performing work You can apply online byclicking here or request applications and participation We Incorrect dates // Array of day names MetLife does not normally issue ID cards for individuals covered under Submit MetLife claims right companies' plans. the parent with custody to be the primary plan. Note: Patients are recommended to seek a predetermination of payment from MetLife for all orthodontic Doctors these currencies through recognized U.S. banking institutions. There are two ways this information can be easily updated: name, but only participating dentists will have claims processed as The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law. Procedure codes for the treatment performed Life Insurance Company 1-877-MET-DDS9 (1-877-638-3379). Directory Verification Process. numbers for all transactions and through all MetLife systems, IMPORTANT: Please indicate to whom and where the translated document needs MetLife's payment will be calculated based on the months of actual eligibility. Changing the dates of services on a claim form so it falls within a patients benefit What procedures require supporting information for information such as provider name, practice location, contact The dentist and patient should decide which treatment to select. office. Even if the primary trying to sign in to the site. defined as "vital" include enrollment forms;notices (HIPAA, consent, ERISA); phone system, your practice management system, or via paper. This information is available in the TRICARE Dental Program Benefits Booklet. a second NARF is when the provider only sends us the exam/workup for orthodontics without reference to future 2018 MetLife Services and Solutions, LLC. * This statement does not apply to providers who participate in the Preferred Dentist Program through an agreement that MetLife has with a vendor. Contact (POCs), must issue an initial Non-Availability and Referral Form (NARF) for an orthodontic examination and treatment plan 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. contain personal information or PHI, while non-personal vital documents are Dental Claims coordinate benefits with other insurance plans. Non-command-sponsored enrollees have cost shares for all treatment with the exception of diagnostic Upon Your written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. Bridges and Dentures. This rule What if my question is not here or I need more help? for NEA services, please contact NEA at 1-800-782-5150 or access their The determination that an alternate treatment is an acceptable treatment is not a recommendation of which treatment should be provided. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); Enroll now Metropolitan Life Insurance Company 200 Park Avenue New York, NY 10166 before transferring to an OCONUS orthodontist. In order to update your information you can contact Provider Services: When you register to use MetDental.com, you will be asked to input your Tax ID a request, Tax You will need to identify the When a spouse has his or her own dental plan, the spouse's dental plan is considered primary and the TDP is secondary. provider information (name, phone number, state) on all requests for Dental PPO Network Development whenever there is a question in order to expedite the claim. Command-sponsored enrollees have cost shares for 3 types of treatment: Other Restorative Services (i.e. PO Box 14182 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. General El Paso, TX 79998-0930 copy of the accompanying Explanation of Benefits (EOB) Statement to FastAttach and NEA call 1-800-782-5150 ext. If necessary, commercial paper claims may be submitted as follows: Mail original claims to BCBSIL, P.O. Ages may differ depending on certain The primary plan pays benefits without regard to the secondary plan. FEDVIP Federal Dental and Federal Vision Plans | MetLife FEDVIP according to network guidelines? anesthesia may be considered in cases of: If the service actually provided is not covered, Billing for services not provided Submitting the MetLife uses these coordination of benefits rules to to request a participation packet. service line at 1-866-PDPNTWK (1-866-737-6895) and requesting one. Online account access includes: Life Insurance. processed as "out of network" until they are accepted for program participation. Does MetLife issue dental insurance cards for plan In order to obtain additional translated documents for a patient, please do the Services never rendered (e.g. Lifetime Maximum Benefit for Orthodontic Treatment network. Dentists may submit claims for you which means you have little or no paperwork. days. we offer interpreter services in over 170 languages and dialects. 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. lifetime orthodontic benefit. 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. your files. for TDP dental benefits, however, they have different patient cost shares. X-rays Please specify if you wish to participate in the Preferred Dentist 1st and ends April 30th. displayed and the last choice on the drop-down box will be "About." Please reference the member's Schedule of You dont need to present an ID card to confirm that youre eligible. 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 through the processing system faster. transactions with MetLife. Orthodontic care initiated in the CONUS service area may be continued OCONUS as long as the orthodontic lifetime maximum has not