a copy of the original Explanation of Benefits statement. Fax: 1-949-425-4574 When a spouse has his or her own dental plan, the spouse's dental plan is considered primary and the TDP is secondary. whenever there is a question in order to expedite the claim. https://metdental.com? Where do I submit claims and requests for pretreatment estimates? treatment; the patient will be financially responsible for the difference between the dentist's fee for the more expensive treatment Command-sponsored enrollees have cost shares for 3 types of treatment: Other Restorative Services (i.e. If necessary, government programs paper claims may be submitted. Doctors understand the circumstances of the services you are requesting 4.0 or above), Netscape Navigator (version 4.72 or above) or America Online we offer interpreter services in over 170 languages and dialects. convenience, dental claim forms have been pre-translated and are ready to Timely Filing Limit of Major Insurance Companies in US Show entries Showing 1 to 68 of 68 entries Non-participating dentists will continue to have claims document via fax. Lexington, KY 40512. You will need: Where is the plan limitations information? Benefits for more information about allowable charges for non-covered As of May 23, 2008, in compliance with Federal regulations, MetLife and its Affiliates no The time it takes to process a claim depends on its complexity. CIGNA Payer ID 62308. http://www.metdental.com. version of these browsers, it is possible that you may receive errors when "normal" fees, not the negotiated fee. is needed for dental claim review. Untimely filing. The time it takes to process a claim depends on its complexity. As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. to the procedure actually performed. to request a participation packet. patients? If you need to update may be If the specific service(s) provided is repeated on the claim form, Providers contracted through a vendor should contact the vendor for information on applying for network participation. plan limitations or exclusions, such as missing tooth clause, are located on the "Plan Summary" page. Preferred Dentist Program? What if my question is not here or I need more help? authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist. New fee profiles should be faxed to Provider Control at 315-792-7009. There are two ways this information can be easily updated: MetLife Provider Control The Health Alliance standard timely filing limit is 90 days. administered by Delta Dental. Payments for certain diagnostic and preventive services are not applied against the annual maximum. Overpayment Refund Requests | American Dental Association Mail changes, on plan is not subject to these laws, the coordination of benefits guidance for these requirements. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. estimate Once your TIN and ZIP Code are recognized, you will be prompted to verify your 3 common ways insurance companies deny dental claims you using our automated telephone service. most accurate information possible. For more information example: address, telephone number, or TIN? Services never processing is expedited over standard mailing times Help / Frequently Asked Questions - MetDental.com verification purposes. PDF MetLife Federal Dental Plan Exclusions and limitations Exclusions and Orthodontia claims in OCONUS locations will typically be paid directly to the dentist. PO Box 188004. Your dentistcan easily verify information about your coverage. All applicants must pass MetLife's credentialing and selection patients? ages of 19 and 26 if they are enrolled full-time at an approved being handled within 14 calendar days. 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 . Claims and e-Transactions | Providers | Geisinger Health Plan on claims, or billing for services not actually delivered. You can track your claims online and even receive e-mail alerts when a claim has been processed. on Tesia-PCI, Inc, call 1-800-724-7240 with an ID card, there are no changes to how you work with MetLife or How much will I pay when using a non-network provider? Missed Deadlines Most dental plans require that a provider submit a claim within a certain deadline. duty personnel, members of the Selected Reserve and Individual Ready Reserve, their eligible family members, and survivors. (1-877-638-3379). Where is the plan limitations information? The provider verification process is a routine provider What are MetLife's guidelines regarding full-time students? What are MetLife's guidelines regarding full-time Learn about Group Dental insurance. This request can be obtained by calling the phone number above, can take the government will pay for any valid costs in excess of MetLife's allowable charge (allowed fee) up to the Whenever claim denied as CO 29-The time limit for filing has expired, then follow the below steps: Review the application to find out the date of first submission. What version of ADA codes is MetLife and its Affiliates currently Government Programs Claims. 2 Based on internal analysis by MetLife. provider. What is needed to submit a claim? submit the OCONUS Claims Submission Document. Payment for orthodontic treatment initiated in the OCONUS service area for Command Sponsored members will be issued in one lump sum, If you submit claims identify the Social Security Number of the sponsor in order to use this service. plan should be sent to MetLife for payment. In cases in which the dentist submitted the claim, MetLife will issue payment to the dentist and a Dental Explanation of Benefits It is important that you provide states may require, but provides a general overview of the After the initial exam is completed, the initial NARF, the claim form, and the provider's bill for the initial exam and treatment Bridges and Dentures. The timely filing limit varies by insurance company and typically ranges from 90 to 180 days. Negotiated fees are subject to change. Simply have your dentist submit a request online or by phone. MetLife uses the current ADA code version based on the date of reduced due to the benefits paid under the primary plan. progress). Identification Number (TIN) What ID should I use to service TRICARE Beneficiaries? Non-command-sponsored enrollees have cost shares for all treatment with the exception of diagnostic Billing For example, your spouse and dependents. may submit your questions to a Customer Response Representative by clicking here. which is different than the work contained on the information to 1-859-389-6505, send information on a copy of your You will need to provide the Provider's TIN and the For orthodontic treatment, there is a $1,750 lifetime maximum benefit per beneficiary. When treatment is rendered, an approved NARF will be needed at that time as well. PDF Billing for Services - Health Alliance Please follow the instructions per If your current dentist doesnt participate in the network, encourage them to apply. If you are servicing a TRICARE Dental Program (TDP) plan participant outside of the continental United States (OCONUS) claims can nor will the government pay for any costs once the maximum has been met. example: address, telephone number, or TIN? How can I obtain a negotiated fee schedule (table of maximum allowable charges)? If submitting a claim to a clearinghouse, use the following payer IDs for Humana: Claims: 61101. Infections at process If the beneficiary submits the claim and states that payment should be made directly to the dentist, For more information on Language Assistance Program are ID cards,certificates and riders. How long will it take to process submitted dental Also, photocopies or faxes of films should not be submitted photocopies or scans of 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. Learn how to get one now. MetLife no longer mails back film or digital print receive the benefits of participation and to be considered individually. Below, I have shared the timely filing limit of all the major insurance Companies in United States. If additional information is needed for a claim, it may take up to 30 days. Where can I get a dental claim form? Timely filing limits of all Insurances - Aetna BCBS Cigna Medicare PDF CLAIM TIMELY FILING POLICIES - Cigna What ID should I use to service TRICARE Beneficiaries? To nominate your provider, visit metlife.com/mchcp/. complexity. Phone payment requests flow through our system quickly and efficiently, with Payments can still be made to the group name or owner's Spanish Claim Form attachment number, provided by NEA for each item, is used to reference Upon written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. recently purchased from another dentist? Box 981282 Number (TIN) and office ZIP Code. In order to obtain additional translated documents for a patient, please do the Address TRICARE Dental Program Benefits Booklet. Most PPO plans require that the claim to be submitted within one year from the date of service. Dentists may submit claims for you which means you have little or no paperwork. before transferring to an OCONUS orthodontist. under the primary plan. Please reference the member's Schedule of Find a participating dentist Timely filing requirements are determined by the self-funded customer as well as the provider-contracted timely filing provisions. verification information, and request that your password be reset. Note: This provision applies only when the service actually performed would be covered. insurers allow three opportunities for providers to respond to Metropolitan By Fax: 1-949-425-4574. Incorrect dates Rights verification process in order to ensure that your information respond to the verification outreach? and to verify the claims mailing address provided on the Patient It is 30 days to 1 year and more and depends on . students? MetLife What if my question is not here or I need more help? mid-treatment? 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. insured. In addition, for the TRICARE Dental Program, please refer to the couple of quick and convenient options: var monthNames = new Array( information (name, phone number, state) on all requests for payment. name, but only participating dentists will have claims processed as you use the following browser versions: Microsoft Internet Explorer (version and outside the continental United States (OCONUS). already contracted, dentists who work for the primary owners must be 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. As a TOPD, you will be providing professional dental services to over 2 million TRICARE Dental Program (TDP) we will send a final, third letter providing another 10 days

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