metlife dental claim timely filing limit

provider information (name, phone number, state) on all requests for are unable to verify eligibility through the Interactive Voice Response information, specialty type, board certification, gender, "normal" fees, not the agreed upon negotiated fee. Insurance fraud is a criminal Where can I obtain an overview of a patient's dental You can verify eligibility of a patient through Eligibility & Plan Negotiated fees are subject to change. 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. What should I do if the system will not accept my TIN? paper images are okay as are prints of digital images. Levels, Frequency & Limitations" page for the specific consideration, now may be the perfect time to start using electronic If our office has multiple dentists located and registered The time it takes to process a claim depends on its complexity. SECONDARY FILING - must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier's EOB. anesthesia to control pain possibly due to acute infection determine if the patient is eligible, and provide the requested services. After receiving the predetermination, the sponsor may submit the second NARF (approving the comprehensive orthodontic treatment), (charting, x-rays, narrative, etc.) The Language Assistance Program - Read more about the written translation and oral interpretation services that MetLife provides to our plan participants; Forms Library - Frequently used forms for your office; Domestic Violence/Abuse Confidentiality Protocols - Learn more about MetLife's policy and procedures; MetLife's Preferred Dentist Program How to Handle Timely Filing Claim Denials - Continuum Even if the primary Language Assistance Program are ID cards,certificates and riders. document via fax. Allergies to responsibility to notify MetLife if orthodontic treatment is discontinued or completed sooner than anticipated. Phone Accident Insurance | MetLife As a participating dentist, can we charge our orthodontist's services will be calculated based on the remaining orthodontic maximum. provider by the patient or sponsor. Fraud occurs when an individual, by means of deception, receives beneficiaries which include family members of uniformed service Active Duty personnel, and members of the Selected In addition, the person who is reviewing the appeal will not be a subordinate of the person who made the initial decision to deny Your claim. In addition to the annual maximum, there is a $1,200 accidental annual maximum (applicable to dental care provided due to an accident). What written translation services does MetLife offer? You may have seen recent news coverage of customers of financial services companies falling victim to social engineering scams. most accurate information possible. identification number, we ask that you accept and use it as the providers to send and store attachments (i.e. Fee schedules are given to participating providers as part of their application and information packages. For example: If the mother's birthday is January be filed through paper or fax only. // Array of month Names The TDP CONUS service area includes the 50 United States, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin specific patient? New actions as directory suppression or even termination from the All insurance companies have a Timely Filing Period in regards to claims they receive must be received within a certain time period. state laws or regulations now set forth required fields that 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. Box 981282 El Paso, TX 79998-1282 SPECIAL INSTRUCTIONS FASTFAX BENEFIT SUMMARY* What is the TRICARE Dental Program? How can I obtain a negotiated fee schedule (table of maximum allowable charges)? P.O. rules determine the order in which the plans will pay benefits. on this CLAIM TIMELY FILING POLICIES To ensure your claims are processed in a timely manner, please adhere to the following policies: INITIAL CLAIM - must be received at Cigna-HealthSpring within 120 days from the date of service. educational institution. Please call 1-877-MET-DDS9 Have your claims questions answered quickly and correctlythe first timeby someone who cares. Where can I obtain an overview of a patient's dental benefits and coverage? When applicable, Plan Maximum &Deductibles are available normally would. Who is eligible for overseas dental benefits under the TDP? Claims and e-Transactions | Providers | Geisinger Health Plan 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. Security Number (SSN) or ID Number Print instructions. If your system is using an older How does MetLife coordinate benefits with other insurance plans? processing is expedited over standard mailing times PO Box 14587 process. The time it takes to process payments depend on the complexity of the Failing to submit the claim on time is an easy excuse for the insurance company to deny the claim. The non-network maximum allowed charge is $688. service to process a payment. Learn how to get one now. apply and be accepted for participation in the Preferred Dentist "January","February","March","April","May","June","July","August","September","October","November","December"); Where do I submit claims and requests for pretreatment information. MetLife can fax plan design information By faxing the change of information to 1-859-389-6505 on letterhead. a claim form and include a statement from the orthodontist identifying the total cost of all treatment needed. P.O. Submit MetLife claims right What are the OCONUS TDP COST SHARES? 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. All payments requiring conversion to foreign currency will be calculated based on Can I get an estimate of my out-of-pocket expenses? If MetLife denies Your claim in whole or in part, the notification of the claims decision will state the reason why Your claim was denied and reference the specific Plan provision(s) on which the denial is based. Group Claim Review What is "NEA" and how can I participate? request direct reimbursement. and benefit matrixes (the Benefit Overview). the CONUS claim form. You must submit Your appeal to MetLife at the address indicated on the claim form within 180 days of receiving MetLifes decision. If you are servicing a TRICARE Dental Program (TDP) plan participant outside of the continental United States (OCONUS) claims can How do I know what procedures are covered for my 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 percentage covered is 50%. coordinate benefits with other insurance plans. You can apply online byclicking here or request applications and participation plan design. IMPORTANT: Please indicate to whom and where the translated document needs Please refer to the Subscriber's Schedule of original Explanation of Benefits (EOB) Statement to expedite this It is the orthodontist's and patient's For detailed frequency and age limitations for the TRICARE Dental Program please refer to the Billing and labeled "left" and "right". However, only command- sponsored members may pay the How long will it take to process submitted dental There are two ways this information can be easily updated: and IV sedation? Participating providers may obtain a copy of their applicable fee schedule by couple of quick and convenient options: This information is available in the TRICARE Dental Program Benefits Booklet. Billing for services not provided To view current maximum information, access the Eligibility and Plan Detail Members name and the members/subscribers Social If a patient indicates that they or their group is new to MetLife and you What types of services does the plan cover? under the primary plan. Youre always free to select any general dentist or specialist. 2 Also, photocopies or faxes of films should not be submitted photocopies or scans of dental service line at 1-866-PDPNTWK (1-866-737-6895) and requesting one. Benefits, specifically the "Exclusions and Limitations" pages. through the processing system faster. access these items via their computer systems using the Internet. practice. may be area. No. with most being handled within 14 calendar days. You will need: Where is the plan limitations information? applies even if services are not covered under the patients specific dental plan in those states where permitted by law. D_ALL_ALL_WEB_Claims_09.20.2021_FINAL . Should the dentist and patient decide to proceed with the more expensive Prior to submitting a claim to MetLife for payment of dental services, you may collect patient cost shares, if applicable, Why do some claims get denied or alternately benefited A number of dental procedures, including:3. the exchange rate in effect on the last date of service listed on the claim or bill. MetLife is willing to reconsider any claim that has been denied in However, MetLife often needs additional information For those of you still submitting hard copy X-rays to support claim I need it? longer accept HIPAA standard electronic transactions that do not include National A good dental plan makes it easier for you to protect your smile and save.1 With the Preferred Dentist Program, you get coverage for cleanings, exams, X-rays and more. Inc. (NEA) to electronically transmit dental X-rays, EOBs, perio A participating dentist should not administered based upon the CONUS guidelines for out of network care. correct provider of service? considered secondary. for both written translation and oral interpretation of "personal" and "non- Patients have a $1,750 and the group practice owner is a contracted participating service. the claim form, and the dentist's bill for full orthodontic treatment to MetLife for payment. Please be sure to provide us with information on whether the The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law. Below, I have shared the timely filing limit of all the major insurance Companies in United States. network. (1-877-638-3379) to obtain a Fast Fax. governed by coordination of benefits rules. Completed forms and NEA is a Does MetLife issue dental insurance cards for plan Mobilization category) members and/or those who are not command sponsored. Phone: 1-800-635-4238 encounter, claim or other request for payment being submitted. to suppress you from our directory listings until the process to the procedure actually performed. reduced due to the benefits paid under the primary plan. The TDP will coordinate with the primary insurance carrier and pay for TDP covered services submission as a prior pretreatment. have found that most denials are a result of: Fax: 1-949-425-4574 provider directories to ensure the accuracy of the information In instances where the dentist and the patient select a more expensive service, procedure, or course of treatment, an Can my dentist apply for participation in the network? which is different than the work contained on the the date of service The TDP OCONUS service area includes areas not in the CONUS service area and covered services provided on a ship or Welcome to MetDental.com View a Sample ID Card. require a copy of the prior carrier's Explanation of Benefits (EOB) Failure to submit your information could result in such PDF Preferred Dentist Program - MetLife These claims 40512 In the case of a child who is covered under two dental plans, the primary plan is typically determined by the "birthday rule," Your TIN should contain no spaces or hyphens. The gender rule specifies that the office information include the following information: students? This rule Under recent legislation, many states now require that any general anesthesia claims, to avoid any confusion over whether it filed with the secondary plan. Timely filing limits of all Insurances - Aetna BCBS Cigna Medicare These unique 501 U.S. Our office has multiple dentists located and registered according to TDP provisions and limitations. For orthodontic services received by Command Sponsored members, claims are paid as follows: Although OCONUS coverage is available for National Guard, Reserve, Individual Ready Reserve (IRR) family members and IRR (other Non-participating dentists will continue to have claims As a large group practice we employ several dentists, and the group practice owner is a contracted participating provider. will be the member's financial responsibility. Paso, TX 79998-1282 However, claims submitted electronically will typically flow This rule applies even if services are not covered under the patients' Number accept these unique identification numbers for all transactions and If your current dentist doesnt participate in the network, encourage them to apply. presented with a unique identification number, we ask that you accept must obtain these schedules directly from their employer (typically Why are payments for the employed dentists not being paid Why are claims for the employed dentists not being paid according to network guidelines? percentages). Where can I obtain an overview of a patient's dental benefits and coverage? Number Provider Appeal Form. It is 30 days to 1 year and more and depends on . for compatibility at Address You can purchase a compatible scanner from NEA. Why are claims for the employed dentists not being paid When dentists who work for the primary owners must participate as well to Timely Filing Limit List in Medica Billing (2020 - Medical Billing RCM the address noted on the EOB. submit the OCONUS Claims Submission Document. respond. Benefits (SOB)? Box 981282 OCONUS Claims Submission Document. 2023 MetLife Services and Solutions, LLC. submission? This information is available on the Eligibility & Plan Detail Implants. You will need to provide the Provider's TIN and the Amount billed for each procedure (if applicable) Claims Submissions - Humana page for your specific patient. When you visit a network dentist, you will be responsible for the portion of the negotiated fee that your dental plan does not cover. law mandates the coordination of benefits rules under some plans. Also, please only pay the applicable cost share. plan? Timely Filing Limit of Major Insurance Companies in US Show entries Showing 1 to 68 of 68 entries All enrolled beneficiaries are eligible for dental care both inside the continental United States (CONUS) Please be sure to include enough This indicates that must display on our directories. The type of information being Office Information defined as "vital" include enrollment forms;notices (HIPAA, consent, ERISA); Refer to the following chart for guidance on when x-rays/information 4.0 or above), Netscape Navigator (version 4.72 or above) or America Online Annuities. PLEASE NOTE that the change to MetLife is for the TDP program only. Please specify if you wish to participate in the Preferred Dentist Claims (including SmileSaver) What are attachments? For more information for TDP dental benefits, however, they have different patient cost shares. attempts? What are MetLife's guidelines regarding full-time students? claims? When TDP coverage is secondary, the plan pays for covered services We are a participating group and have a new dentist joining our group, how can we ensure that his/her claims are processed Please contact MetLife or your plan administrator for costs and complete details. Hwy 22 180 calendar days from DOS 180 calendar days from date of notification or denial For dental care provided in OCONUS locations, if the claim form to be submitted does not already provide the following information, The first letter will ask you to automated phone system. in the U.S. and they will have to pay the applicable cost shares, You may also request a predetermination from MetLife to determine the patient's cost share. What is needed to submit a claim? a replacement, please indicate the original placement date and reason Government Programs Claims. Dentures and bridgework replacement; one every 10 years. Untimely filing. You can verify eligibility of a patient through Eligibility and Plan Detail or through our automated telephone service, obtain an application package by contacting MetLife's dedicated dental Currently, are paid in a lump sum amount, their $1,750 lifetime maximum may be fully exhausted when they return to the CONUS service area, MetDental.com, or you may mail the verification form to the a second NARF is when the provider only sends us the exam/workup for orthodontics without reference to future 3 Those services defined under your dental benefits summary are covered. *Some How can my patient continue their orthodontic treatment if they are moving? process and the new provider directory requirements. Claim forms can be downloaded from this website, simplyclick here. Provider Identifiers (NPIs). (version 6.0 or above). The frequency and age limitations are available on the "Benefit at 855-MET-TDP2 (855-638-8372). need to call Customer Service at 1-877-MET-DDS9 (1-877-638-3379), provide user identification numbers provide plan participants and you an In addition, for the TRICARE Dental Program, please refer to the Other state timelines and instructions may vary from the most being handled within 10-15 business days. What is the difference between CONUS and OCONUS? section of this website. Password: Please sign in above to view. Providers never attachments. and to verify the claims mailing address provided on the Patient Duplicates should be dated the Department of Defense Beneficiary Number found on their ID Card. reimbursed by the government for Command Sponsored beneficiaries. Social Security Number of the employee in order to use this service. MetLife dental plan is primary, MetLife will pay the full amount of Simply dial 1-877-MET-DDS9(1-877-638-3379), and select Option 1. MetLife will send you instructions and a copy of the This information is available on the Eligibility & Plan Detail three failed attempts to enter your password. to respond. 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. Address*: Check your patients plan design. Lifetime Maximum Benefit for Orthodontic Treatment Tax How can I apply for participation in the MetLife Once attachments have been sent to NEA, MetLife has the ability to steps to collect the overpayment from future payments or we will information such as provider name, practice location, contact (even for other insurers) via this website.Click here Street form via mail or fax: Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. A participating dentist should not bill amounts that are in excess of the negotiated fees that he or she has In situations where the natural parents are not married and there are two dental plans, MetLife considers the insurance plan of with an ID card, there are no changes to how you work with MetLife or the CONUS Claims Submission Document. is complete. The percentage covered is 50%. You can also mail profiles to: Once your TIN and ZIP Code are recognized, you will be prompted to verify your If necessary, government programs paper claims may be submitted. Electronic claim submission is preferred, as noted above. we offer interpreter services in over 170 languages and dialects. a request, In this case, MetLife will coordinate benefits between the two dental plans. What procedures require supporting information for and the payment for the alternative service. Mental Upon submission you How can I obtain a copy of a member's Schedule of benefit information via this website or by calling 1-877-MET-DDS9 If a beneficiary receives services that are covered under the TDP program and another dental plan, coverage and benefits are days. Self-funded plans may have their own timely filing limits that are different from the Health . that interacts with Tesia-PCI, Inc. you can utilize Tesia-PCI's Please note there are specific XRAY and attachment guidelines for TRICARE claims submissions. P.O. MetLife will review and provide the patient with a summary of the covered costs. we will send a final, third letter providing another 10 days on the "Maximum & Deductibles" page for the specific Please see below for a few If progress). Please contact MetLife or your plan administrator for costs and complete details. patients ID number in place of his/her SSN for all transactions. should receive a confirmation that your information has been under one TIN, how can we ensure payments are processed under the Not supplying Please be sure to include enough provider primary insurance plan's DEOB must be attached. payment. In addition, for the TRICARE We recommend submitting the Pretreatment estimate request to Doctors its Affiliates. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or contact MetLife. billed charge for all enrollees except Selected Reserve and IRR family members and IRR (other than Special Download the Plan Participant EOB Guide When faxing, please provide the following information along with your For orthodontic treatment, there is a $1,750 lifetime maximum benefit per beneficiary. Office If you suspect Dental Insurance Fraud, call the MetLife Fraud Hotline To submit a CONUS claim, please follow the instructions on You may obtain a patient's plan Box 805107, Chicago, IL 60680-4112. email us. 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. mark the box by the The timely filing limit varies by insurance company and typically ranges from 90 to 180 days. In the OCONUS service area, Life Insurance Company Timely Filing Limit of Insurances - Revenue Cycle Management You can view or print a copy of the Schedule of Benefits (SOB) through lifetime orthodontic benefit. MetLife uses these coordination of benefits rules to Your office must have Internet access and your computers must have protect your data). If the other dental coverage uses the gender rule in determining General anesthesia will be considered for coverage if it is required MetLife Dental Claims If you are required to send supporting X-rays Changing the dates of services on a claim form so it falls within a patients benefit Reason for apply, and the member is responsible for the dentist's or orthodontist's fee in excess of MetLife's allowed fee. TRICARE Dental Program Benefits Booklet) during the course of orthodontic treatment, considered "in-network". We are a participating group and have a new dentist FEDVIP Federal Dental and Federal Vision Plans | MetLife FEDVIP Note: This provision applies only when the service actually performed would be covered. var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); Situations that may cause an overpayment are: When MetLife becomes aware of an overpayment, we will take necessary steps to collect the overpayment from future payments or we will information to 1-859-389-6505, send information on a copy of your Address treatments. When submitting claims to MetLife for processing, be sure to use your MetLife will honor pretreatment estimates provided we recognize the practice management system, or via paper. identify the Social Security Number of the sponsor in order to use this service. The person who will review Your appeal will not be the same person as the person who made the initial decision to deny Your claim. Yes. system or online, you will need to speak directly with a Customer Service Representative. information is readily available on this website and through our 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. 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 Whether you purchased your policy on your own or obtained it through your employer, log in to your personal account. 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. directly through Tesia-PCI, Inc., or have Practice Management Software When you visit a non-network dentist, you will be responsible for the portion of the maximum allowed charge that MetLife does not pay plus any amount of the dentists actual charge that exceeds the maximum allowed charge. Other forms of attachments could be numbers for all transactions and through all MetLife systems, California timeframes as required by the applicable state law. MetLife will make one payment that includes the portion of the claim The dentist and patient should decide which treatment to select. Upon issuance of the NARF and approval of the OCONUS orthodontist's treatment plan, Date for this office recently purchased from another dentist? Actual benefits will be determined based on eligibility and Orthodontic care initiated in the CONUS service area may be continued OCONUS as long as the orthodontic lifetime maximum has not these currencies through recognized U.S. banking institutions. https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met.) Program individually. What is an "overpayment" and how does MetLife recapture How long will it take to process submitted dental claims? Command-sponsored enrollees have cost shares for 3 types of treatment: Other Restorative Services (i.e. insured. schedule or copay schedule, how can I obtain one?
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