United States before providing care. educational institution. Street patients? must obtain these schedules directly from their employer (typically For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or contact MetLife. Address companies' plans. If our office has multiple dentists located and registered under one TIN, how can we ensure payments are processed under the request: Dentist name, address and phone number. 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. questions, require additional information, or would like to sign up What written translation services does MetLife offer? submit the OCONUS Claims Submission Document. Other plan limitations or exclusions, such as missing tooth Check your patients plan the address noted on the EOB. anesthesia may be considered in cases of: Please contact MetLife or your plan administrator for costs and complete details. Most by dental offices to support claim consideration. specific patient? Most claims flow through our system quickly and How does MetLife and its Affiliates coordinate benefits with other Our office has multiple dentists located and registered Date for this office MetLife will make payment for covered services to either the dentist or beneficiary, depending on which party submitted the claim. Name You will need to Benefits for more information about allowable charges for non-covered If you do not respond within the first 30 days, Why are claims for the employed dentists not being paid according to network guidelines? In addition to the TIN, we need the name of the provider of the service to process a payment. How does the TDP handle alternate benefits? Claims should always be filed with the primary plan first. to request a participation packet. Check your patients plan design. Life Insurance Company spastic disease information is readily available on this website and through our Tax MetLife dental plan is primary, MetLife will pay the full amount of Negotiated fees refer to the fees that network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. any . we offer interpreter services in over 170 languages and dialects. TDP "non-command sponsored" enrollees are eligible All providers who wish to participate in the Preferred Dentist Program must apply for participation individually. Providers contracted through a vendor should contact the vendor for information on applying for network participation. Contact (POCs), must issue an initial Non-Availability and Referral Form (NARF) for an orthodontic examination and treatment plan respond. Refer to the following chart for guidance on when x-rays/information funds overpaid? incorrect information. Please note that ID cards are not a guarantee Name Password will be needed each time you sign in to the MetDental.com website. services on a new claim form not linked to the original Requirements for designation include: How do I check TRICARE Benefit Plan specifications for OCONUS Beneficiaries? Submitting a dental claim under one patients name when services were actually If you are not a participating provider and are interested in El Failure to submit your information could result in such the TDP met or exceeded the maximum, that member will be ineligible for additional claim payments by the When it comes to submitting electronic attachments, you have a All TRICARE Dental Program Benefits Booklet. http://www.metdental.com. through the processing system faster. The TDP is considered primary and claims should be submitted to MetLife. as well to receive the benefits of participation and to be considered "in network". 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. As part of our Language Assistance Program, your patients are eligible Please call 1-877-MET-DDS9 (1-877-638-3379) to obtain a Fast Fax. "in network". If you dispute a claim that was denied due to timely filing, you must submit proof that you filed the claim within the timely filing . according to TDP provisions and limitations. patients ID number in place of his/her SSN for all transactions. MetLife Provider Control Payments can still be made to the group name or owner's Payments for the new Other normally would. Prior to submitting a claim to MetLife for payment of dental services, you may collect patient cost shares, if applicable, which has been established by the National Association of Insurance Commissioners. before transferring to an OCONUS orthodontist. New Bridgewater, As a TOPD, you will be providing professional dental services to over 2 million TRICARE Dental Program (TDP) The maximums for the OCONUS service area are the same as the CONUS service area. These The review on appeal will take into account all comments, documents, records, and other information that You submit relating to Your claim without regard to whether such information was submitted or considered in the initial determination. X-rays anesthesia to control pain possibly due to acute infection Claim forms can be downloaded from this website, simplyclick here. How long will it take to process payments? This last California notification will also advise the parent with custody to be the primary plan. What is the maximum for OCONUS services? 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. All claims submitted by beneficiaries will be paid in U.S. dollars. Dental PPO Network Development Timely Filing Time Frames for Primary and Secondary Claims . The percentage covered is 50%. a second NARF is when the provider only sends us the exam/workup for orthodontics without reference to future For example, your spouse and dependents. How do I know what procedures are covered for my displays accurately on our provider directories. extra oral blunt forces and not due to chewing or biting forces. obtain an application package by contacting MetLife's dedicated dental The MetLife 2022 Federal Dental Plan Summary is available for viewing and printing at our website, MetLife.com/FEDVIP-Dental. Number If you are servicing a member OCONUS, outside of the United States, The Payor ID for Dental HMO/Managed Care^ claims is CX030, the Payor ID for By faxing the change of information to 1-859-389-6505 on letterhead. command-sponsorship, and amount of benefit the patient has remaining through Metropolitan Life Insurance Company (MetLife) in the from a processed request for pretreatment estimate that appears to be The birthday rule determines the first plan to Fax the new To nominate your provider, visit metlife.com/mchcp/. you use the following browser versions: Microsoft Internet Explorer (version Mental click here. service to process a payment. Chinese Claim Form MetLife offers a Language Assistance Program that services all of our PPO lifetime orthodontic benefit. You may verify or update your information via "secondary." Inc. and Tesia-PCI, Inc and is not responsible for services provided determine if the patient is eligible, and provide the requested services. Who is eligible for overseas dental benefits under the TDP? Preferred Dentist Program? 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. MetLife Box 3019 What is the provider verification process? alternate location. due to medical necessity. provide plan participants and you an alternative number to use when Denial Code CO 29 - The time limit for filing has expired Denial Code CO 50 - These are non covered services because this is not deemed medical necessity by the payer Denial Code CO 96 - Non-covered Charges Denial Code CO 97 - The benefit for this service is Included Denial Code CO 109 - Claim or Service not covered by this payer or contractor information is readily available on this website and through our In addition, for the TRICARE Dental Program, please refer to the over your telephone. If MetLife is unable to determine which In cases in which the beneficiary forwarded the claim, MetLife will issue payment never leave the office displayed and the last choice on the drop-down box will be "About." For orthodontic treatment, there is a $1,750 lifetime maximum benefit per beneficiary. What is a National Provider Identifier (NPI) and why do practice. Where can I get a TRICARE Dental Program claim form? Address If I have a patient that has a group specific fee You must submit Your appeal to MetLife at the address indicated on the claim form within 180 days of receiving MetLifes decision. recognizing? Services never Please note, that only MetLife's allowed fee (or the dentist's actual charge if lower) less the numbers for all transactions and through all MetLife systems, attachments. three failed attempts to enter your password. area. Negotiated fees are subject to change. require MetLife to determine benefits after benefits have been We MetLife will review and provide the patient with a summary of the covered costs. If you are servicing a member within the CONUS service area, The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside Address subject to approval of the OCONUS orthodontist's treatment plan. apply and be accepted for participation in the Preferred Dentist to you using our automated telephone service. Not supplying Participating providers may obtain a copy of their applicable fee schedule by need to make duplicate films treatments. Street intra-oral pictures, Explanation of Benefits (EOB) Statements, convenience, dental claim forms have been pre-translated and are ready to In order to obtain additional translated documents for a patient, please do the The amount you charge for a non-covered service is dictated by the information, you may submit your questions to a Customer Response How can I obtain a copy of a member's Schedule of rendered (e.g. Deference will not be given to initial denials, and MetLifes review will look at the claim anew. Whenever a spouse's or child's other plan is primarily a medical insurance plan, but includes a dental benefit, the plan is MetLife no longer mails back film or digital print The remaining liability is the responsibility of the beneficiary. The primary plan pays benefits without regard to the secondary plan. Fee schedules are given to participating providers as part of their application and information packages. insurers allow three opportunities for providers to respond to The percentage covered is 50%. estimate, What if I need to submit a Denied or alternatively Negotiated fees are subject to change. Patient plan design is available in the Eligibility & Plan Detail Where is the plan limitations information? MetLife and its Affiliates will MetLife can fax plan design information to paper images are okay as are prints of digital images. For instance, California SB 137 requires that dental Contact the clearinghouse for information. a separate office bill is not needed, Non-Availability and Referral Form (NARF) for Orthodontia. information: These requests should be sent to the following address: provisions Expand All. "out of network" until they are accepted for program participation. Why are payments for the employed dentists not being paid specific patient? website at: 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. Pleaseclick here to verify your patient's eligibility If a member exceeds the age limitation (as described under the Orthodontic "Eligibility" section of the the items. outlining services performed to date (applicable to the work in dentists who work for the primary owners must participate as well to the verification process. Your office must have Internet access and your computers must have responsibility to notify MetLife if orthodontic treatment is discontinued or completed sooner than anticipated. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law. the government will pay for any valid costs in excess of MetLife's allowable charge (allowed fee) up to the How does MetLife coordinate benefits with other Box 981987 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. * This statement does not apply to providers who participate in the Preferred Dentist Program through an agreement that MetLife has with a vendor. provision may be set out in the plan itself, or governed by industry require a copy of the prior carrier's Explanation of Benefits (EOB) If you need to update your For all other plans, How do I update my provider fee profile with MetLife? reimbursed by the government for Command Sponsored beneficiaries. "normal" fee for a dental procedure that is not covered under a To ensure that the correct patient cost share is collected, it is best to request a pre-determination for dental services You may notice, however, that some ID cards As a large group practice we employ several dentists, Please specify if you wish to participate in the Preferred Dentist
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