a copy of the accompanying Explanation of Benefits (EOB) Statement to the address noted on the EOB. party forwarded the claim, payment will be issued to the dentist. 2023 MetLife Services and Solutions, LLC. Patients have a $1,750 directly through Tesia-PCI, Inc., or have Practice Management Software Identification Number (TIN) plan should be sent to MetLife for payment. National Electronic Attachments, Inc. (NEA) is used by dental If a beneficiary receives services that are covered under the TDP program and another dental plan, coverage and benefits are utilize NEA services. This rule applies even if services are not covered under the patients' the required frequency of verifying provider information. No. If additional information is needed for a claim, it may take up to 30 days. Initial placement to replace one or more natural teeth, which are lost while covered by the plan. In the OCONUS service area, How long will it take to process submitted dental claims? and IV sedation? be filed through paper or fax only. couple of quick and convenient options: patient eligibility, plan detail, and claims information. Other plan limitations or exclusions, such as missing tooth the mailing and pay close attention to the timelines mentioned 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. If you need a claim form, visit www.metlife.com/mybenefits or call1 800 942-0854. condition or physical/mental condition which requires the patient After payment has been received from the primary plan, the claim can be educational institution. When faxing, please provide the following information along with your If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan, subject to applicable law. For services other than Orthodontia, MetLife TRICARE Dental Program Program individually. requested language (Spanish or Chinese) * Use this form to authorize someone else to access your information in order to help you manage your dental and/or vision benefits. insurance plans? displayed and the last choice on the drop-down box will be "About." Even if a dentist is a member of a group practice, he or she must also Find a participating dentist What if my question is not here or I need more help? If your current dentist doesnt participate in the network, encourage them to apply. To view current maximum information, access the Eligibility and Plan Detail section of this website. The Payor ID for Dental HMO/Managed Care^ claims is CX030, the Payor ID for "About" entry to display the version of the browser. Can I get an estimate of my out-of-pocket expenses? For orthodontic treatment, there is a $1,750 lifetime maximum benefit per beneficiary. TRICARE Dental Program Benefits Booklet. In some cases, eligibility information may be delayed for new enrollees. defined as "vital" include enrollment forms;notices (HIPAA, consent, ERISA); The government will not pay for the portion of the enrollees maximum that has already been paid by MetLife To request electronic versions of TDP materials, please "in network". in the correspondence. any . New fee profiles should be faxed to Provider Control at 315-792-7009. If the parent with custody has remarried, the stepparent's plan will pay before identification numbers provide plan participants and you an for TDP dental benefits, however, they have different patient cost shares. What is an "overpayment" and how does MetLife recapture a separate office bill is not needed, Non-Availability and Referral Form (NARF) for Orthodontia. Identification Number (TIN) PDF Dental Claim Form - MetLife including MetDental.com, 1-877-MET-DDS9 (1-877-638-3379), your What are the guidelines regarding full-time Providers interested in participation may obtain an application package by contacting MetLife's dedicated The timely filing limit varies by insurance company and typically ranges from 90 to 180 days. If we do not receive your confirmation or updated benefited claim for reconsideration? You can purchase a compatible scanner from NEA. We recommend that you request a pre-treatment estimate for services totaling more than $300. Timely Filing Limit of Major Insurance Companies in US Show entries Showing 1 to 68 of 68 entries students? regardless of whether or not the orthodontic care was completed. MetLife is not affiliated with National Electronic Attachment Inc. and Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. area. full details of the information required to be completed for additional information is needed for a claim, it may take up to 30 Whether the appeal is the first or second appeal of the initial determination. Please specify if you wish to participate in the Preferred Dentist Pleaseclick here to verify your patient's eligibility This process takes approximately 4 weeks. IMPORTANT: Please indicate to whom and where the translated document needs Timely Filing Limit of Insurances - Revenue Cycle Management Mail changes, on individually. And what if they change insurance carriers in provider. SECONDARY FILING - must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier's EOB. Please reference the member's Schedule of Timely filing requirements are determined by the self-funded customer as well as the provider-contracted timely filing provisions. Does MetLife issue ID cards for Box 981987 Electronic claim submission contain personal information or PHI, while non-personal vital documents are If submitting a claim to a clearinghouse, use the following payer IDs for Humana: Claims: 61101. For more information When it comes to submitting electronic attachments, you have a via the Human Resources dept.). Box 14589 In instances where the dentist and the patient select a more expensive service, procedure, or course of treatment, an Inc. and Tesia-PCI, Inc and is not responsible for services provided 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. Deference will not be given to initial denials, and MetLifes review will look at the claim anew. "normal" fees, not the agreed upon negotiated fee. Manage your employee benefits the Department of Defense Beneficiary Number found on their ID Card. pretreatment estimate paid as actual claim), Member pays cost share based on lesser of dentist's actual charge or MetLife's allowed fee, Specific tooth/teeth treated for each service performed, where appropriate, If a procedure code is not provided on the claim form, a complete description of the service performed, would have paid as the primary carrier, whichever is less. Original items narratives) via the Internet. directories. Or, call 1-877-MET-DDS9 (1-877-638-3379) MetLife uses the current ADA code version based on the date of In no instances should the total payments for a service by the primary and Most PPO plans require that the claim to be submitted within one year from the date of service. apply and be accepted for participation in the Preferred Dentist according to network guidelines? your letterhead, to: NEA will keep the attachments online for 3 years and then to complete the form and click submit. Chinese Claim Form Each plan year begins May Lexington, KY nor will the government pay for any costs once the maximum has been met. For example, if any patient gets services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement. Once attachments have been sent to NEA, MetLife has the ability to Timely Filing Limit List in Medica Billing (2020 - Medical Billing RCM Documents You must submit Your appeal to MetLife at the address indicated on the claim form within 180 days of receiving MetLifes decision. 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. The type of information being Number (TIN) and office ZIP Code. Phone Dentists may submit claims for you which means you have little or no paperwork. Please reference your specific letter for the procedure of eligibility, and are primarily used for easy reference to commonly on this trying to sign in to the site. For detailed frequency and age limitations for the TRICARE Dental Program please refer to the ensure the accuracy of the provider directory information. Chattanooga, TN 37422. the date of service on the approved pretreatment estimate form or listed. Where is the plan limitations information? Payments for certain diagnostic and preventive services are not applied against the annual maximum. State the parent with custody to be the primary plan. patients' claims and pretreatment estimates should be submitted to an Billing for services not provided Below, I have shared the timely filing limit of all the major insurance Companies in United States. electronically through a claims clearinghouse or through paper and fax. https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met.) Address Incorrect PDF MetLife Federal Dental Plan Exclusions and limitations Exclusions and After the initial exam is completed, the initial NARF, the claim form, and the provider's bill for the initial exam and treatment Total Control Accounts. What version of ADA codes is MetLife currently How long will it take to process payments? Orthodontic diagnostic services will be Your patients is a set of rules that are followed when a patient is covered by more Preferred Dentist Program? The frequency and age limitations are available on the "Benefit Street https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met. name, but only participating dentists will have claims processed as This information is available in the TRICARE Dental Program Benefits Booklet. actions as directory suppression or even termination from the 1-877-MET-DDS9 (1-877-638-3379) and requesting one from the automated phone system. information such as provider name, practice location, contact