What is dental insurance fraud?
Dental insurance fraud is a crime that costs honest consumers and businesses money. Fraud occurs when an individual, by means of deception, receives insurance payments after filing a false claim, inflating costs of services performed on claims, or billing for services not actually delivered. Insurance fraud is a criminal activity that the industry is committed to pursuing and prosecuting.

What are some examples of dental insurance fraud?
    º Billing for services not provided
    º Reporting a higher level of dental service than was actually performed, this is often called "upcoding"
    º Submitting a dental claim under one patients name when services were actually provided to another person
    º Changing the dates of services on a claim form so it falls within a patients benefit period

What can I do if I suspect dental insurance fraud?
If you suspect Dental Insurance Fraud, call the MetLife Fraud Hotline at 1-800-462-6565.

What is a National Provider Identifier (NPI) and why do I need it?
As of May 23, 2008, in compliance with Federal regulations, MetLife and its affiliates no longer accept HIPAA standard electronic transactions that do not include National Provider Identifiers (NPIs). Still need an NPI? Learn how to get one now.

What is MetLife's Language Assistance Program?
MetLife offers a Language Assistance Program that services all of our PPO and Dental HMO / Managed Care plan participants regardless of situs state,insured vs. ASO, or state of residence.
As part of our Language Assistance Program, your patients are eligible for both written translation and oral interpretation of "personal" and "non- personal" vital documentation. Personal vital documents are any items that contain personal information or PHI, while non-personal vital documents are generic materials that do not contain personalized information. Documents defined as "vital" include enrollment forms;notices (HIPAA, consent, ERISA); EOBs; certain participant letters(eligibility, participation, plan benefit,claims); and benefit matrixes (the Benefit Overview). Materials not included in our Language Assistance Program are ID cards,certificates and riders.

What written translation services does MetLife offer?
MetLife offers written translation services to all our plan participants. The languages available for written documents are Spanish and Chinese. For your convenience, dental claim forms have been pre-translated and are ready to use. You can download the translated forms by clicking on the following links:
     Spanish Claim Form
     Chinese Claim Form
In order to obtain additional translated documents for a patient, please do the following:
      •   open the LAP Notice of Rights
      •   print it out
      •   mark the box by the requested language (Spanish or Chinese)
      •   mail the document needed to be translated along with the form to:
           Metropolitan Life Insurance Company
           PO Box 14587
           Lexington, KY 40512
IMPORTANT: Please indicate to whom and where the translated document needs to be sent and retain a copy of the material for your records. It may take up to 21 calendar days to receive the translated documents

What oral interpretation services does MetLife offer?
MetLife offers oral interpretation services to all our plan participants. In order to obtain oral interpretation for your patients, simply call 1-800-942-0854 and provide us with the patient's name and identification number. We will then determine if the patient is eligible, and provide the requested services. Currently, we offer interpreter services in over 170 languages and dialects.
California plan participants also have the ability to request an interpreter on-site at the dental office. This request can be obtained by calling the phone number above, can take approximately 3 days to schedule and is available for your California patients only.

Why does my computer change the web address I insert to https://metdental.com?
A web address that changes to begin with https:// is correct. This indicates that the site is a secure socket site with 128-bit encryption (a security feature to protect your data). There is an automatic redirect if someone enters http://www.metdental.com. Access to this encrypted site requires that your browser properties be set to 128-bit encryption and cookies enabled and that you use the following browser versions: Microsoft® Internet Explorer (version 4.0 or above), Netscape Navigator® (version 4.72 or above) or America Online® (version 6.0 or above). You may upgrade your browser for free at www.microsoft.com or www.netscape.com. If your system is using an older version of these browsers, it is possible that you may receive errors when trying to sign in to the site. To verify the browser version you are using, click on the "Help" button on your browser menu bar. A drop-down box will be displayed and the last choice on the drop-down box will be "About." Choose the "About" entry to display the version of the browser.

Is there a security system in place to limit the number of incorrect log-ins attempts?
Yes. To guard against unauthorized access, a security lockout is activated after three failed attempts to enter your password. If a lockout is activated, you will need to call Customer Service at 1-877-MET-DDS9 (1-877-638-3379), provide user verification information, and request that your password be reset.

What should I do if the system will not accept my TIN?
When you register to use MetDental.com, you will be asked to input your Tax ID Number (TIN) and office ZIP Code. Your TIN should contain no spaces or hyphens. Once your TIN and ZIP Code are recognized, you will be prompted to verify your address and then to select a User name and Password. Your User name and Password will be needed each time you sign in to the MetDental.com website. If the system does not accept the TIN you input you will need to contact 1-877-MET-DDS9 (1-877-638-3379).

What if my question is not here or I need more help?
If your question is not listed here or if you need additional information, you may submit your questions to a Customer Response Representative byclicking here.

Where can I get a dental claim form?
Claim forms can be downloaded from this website, simplyclick here.

What is MetLife's Payor ID for electronic claims submission?
MetLife's Payor ID for electronic claims is 65978.

Where do I submit claims and requests for pretreatment estimates?
There are four options available to submit claims and requests for pretreatment estimates:
      •   Electronic claim submission (even for other insurers) via this website.Click here            for more details.
      •   Submit MetLife claims right over your telephone. Simply dial           1-877-MET-DDS9(1-877-638-3379), and select Option 1.
      •   Send your completed claim forms via US Mail to the following address:
               º  MetLife Dental Claims
                   P.O. Box 981282
                   El Paso, TX 79998-1282
      •   Fax your claims, dial 1-859-389-6505.
      •   If you have trouble identifying a patient's group number, please call the MetLife           Customer Service Call Center at 1-877-MET-DDS9 (1-877-638-3379) for additional           information. Please note some groups have multiple group numbers and plan           designs.

How long will it take to process submitted dental claims?
The time it takes to process a claim depends on its complexity. Most claims flow through our system quickly and efficiently, with most being handled within 10 business days. If additional information is needed for a claim, it may take up to 30 days. However, claims submitted electronically will typically flow through the processing system faster.

How does MetLife coordinate benefits with other insurance plans?
A coordination of benefits (COB) provision in a dental benefits plan is a set of rules that are followed when a patient is covered by more than one dental benefits plan for a particular dental service. These rules determine the order in which the plans will pay benefits. State law mandates the coordination of benefits rules under some plans. If a plan is not subject to these laws, the coordination of benefits provision may be set out in the plan itself, or governed by industry practice. MetLife uses these coordination of benefits rules to determine whether the MetLife dental benefits plan is "primary" or "secondary."
      •  If the MetLife dental plan is primary, MetLife will pay the full amount of           benefits that would normally be available under the plan.
      •  If the MetLife dental plan is secondary, most coordination of benefits           provisions require MetLife to determine benefits after benefits have been           determined under the primary plan. The amount of benefits payable by MetLife           may be reduced due to the benefits paid under the primary plan.

Is there any additional information that would help expedite the processing of claims containing crowns, bridges, or dentures?
Please be sure to provide us with information on whether the prosthetic is an initial placement or replacement appliance. If it is a replacement, please indicate the original placement date and reason for replacement.

What procedures require supporting information for claim submission and what type of supporting information is needed?
Refer to the following chart for guidance on when x-rays/information is needed for dental claim review. Your submission of x-rays should be the most recent available to you. MetLife does not require you to take x-rays that you did not require in your professional judgment. X-rays should be dated, labeled, and of diagnostic quality.

MetLife will no longer mail back film or digital print X-rays sent in by dental offices to support claim consideration. If you are required to send supporting X-rays with a claim, please submit a duplicate and retain the original for your files. Duplicates should be dated and labeled "left" and "right".

Also, photocopies or faxes of films should not be submitted - photocopies or scans of paper images are okay as are prints of digital images.

How are complex dental claims reviewed?
Experienced dentists are used as consultants to review complex dental claims. These professionals make recommendations based on the documentation (x-rays, charts, and narrative notes) submitted by your office.

Why do some claims get denied or alternately benefited from a processed request for pretreatment estimate that appears to be approved?
MetLife will honor pretreatment estimates provided we recognize the submission as a prior pretreatment. It is important that you provide the date of service on the approved pretreatment estimate form or attach the approved estimate form to the claim you are submitting. We have found that most denials are a result of:
      •  Not supplying the date of service
      •  Submitting the services on a new claim form not linked to the original           pretreatment estimate
      •  Performing work which is different than the work contained on the           pretreatment estimate

What if I need to submit a Denied or alternatively benefited claim for reconsideration?
MetLife is willing to reconsider any claim that has been denied in whole or in part, or that has had alternate benefit provisions applied. However, MetLife often needs additional information (charting, x-rays, narrative, etc.) that will help us better understand the circumstances of the services you are requesting reconsidered. Also, please ensure that you provide a copy of the original Explanation of Benefits (EOB) Statement to expedite this process.

These requests should be sent to the following address:
        MetLife
        Group Claim Review
        P.O. Box 14589
        Lexington, KY 40512

How should we submit claims for a patient who changes insurance carriers? And what if they change insurance carriers in mid-treatment?
Submit claims to MetLife for new services provided to patients as you normally would. For any work "in progress" from a time when the patient was covered under another dental benefits plan, submit a copy of the Explanation of Benefits (EOB) Statement from the prior carrier outlining services performed to date (applicable to the work in progress). Actual benefits will be determined based on eligibility and plan design.

Do MetLife PDP dental plans pay for general anesthesia and IV sedation?
General anesthesia will be considered for coverage if it is required due to medical necessity. When there is a compromising medical condition or physical/mental condition which requires the patient receive general anesthesia to have the dental work performed, general anesthesia will normally be allowed. You should submit a narrative whenever there is a question in order to expedite the claim. General anesthesia may be considered in cases of:
      •  Mental retardation
      •  Unmanageable patients due to age−up to 7 years
      •  Patients with spastic disease
      •  Infections at injection site where local anesthetic would normally be administered
      •  Allergies to local anesthesia
      •  Failure of local anesthesia to control pain possibly due to acute infection
      •  Extended surgery
MetLife recommends that a request for pretreatment is submitted for any general anesthesia claims, to avoid any confusion over whether it is medically necessary or not.

What version of ADA codes is MetLife currently recognizing?
MetLife uses the current ADA code version based on the date of service.

What are attachments?
Attachments are documents that support dental claims, such as x-rays or periodontal charting. Other forms of attachments could be intra-oral pictures, narratives, or Explanation of Benefits (EOB) Statements.

Electronic Attachments are exactly the same as regular attachments, only the dental office can submit them through an electronic channel. MetLife has made arrangements with an electronic attachment vendor, NEA (National Electronic Attachment, Inc) for you to submit x-rays and other attachments to MetLife electronically. For more information and to sign up with NEA, call 1-800-782-5150 or access their website at: https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met. MetLife is not affiliated with National Electronic Attachment Inc. and is not responsible for services provided by them.

What is "NEA" and how can I participate?
National Electronic Attachments, Inc. (NEA) is used by dental providers to send and store attachments (i.e. x-rays, perio-charts, intra-oral pictures, Explanation of Benefits (EOB) Statements, narratives) via the Internet. NEA is an electronic attachment vendor. Once attachments have been sent to NEA, MetLife has the ability to access these items via their computer systems using the Internet. An attachment number, provided by NEA for each item, is used to reference the items. NEA will keep the attachments online for 3 years and then the attachments are sent to be archived. There are several reasons for a provider to use NEA:

      •  NEA is a supplement to electronic claims, allowing a complete electronic process
      •  Providers never need to make duplicate films
      •  Original items never leave the office
      •  Claims processing is expedited over standard mailing times

Your office must have Internet access and your computers must have minimum software and hardware standards, including a scanner to utilize NEA services. You can purchase a compatible scanner from NEA. (If you wish to purchase a scanner on your own you should contact NEA for compatibility at https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met.) MetLife is not affiliated with National Electronic Attachment Inc. and is not responsible for services provided by them. If you have any questions, require additional information, or would like to sign up for NEA services, please contact NEA at 1-800-782-5150 or access their website at:
https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met

As a participating PDP dentist, can we charge our "normal" fee for a dental procedure that is not covered under a patient's dental plan?
A participating Preferred Dentist Program (PDP) dentist should not bill amounts that are in excess of the PDP fees that he or she has agreed to accept as payment for services to plan Employees. This rule applies even if services are not covered under the patient' specific dental plan in those states where permitted by law. When submitting claims to MetLife for processing, be sure to use your "normal" fees, not the agreed upon PDP fee.

We are a participating PDP group and have a new dentist joining our group, how can we ensure that his/her claims are processed according to the PDP (or in-network)?
Even if a dentist is a member of a group practice, he or she must also apply and be accepted for participation in the Preferred Dentist Program (PDP) individually. Providers interested in participation may obtain an application package by contacting MetLife's dedicated dental service line at 1-866-PDPNTWK (1-866-737-6895) and requesting one. All applicants must pass MetLife's credentialing and selection criteria to be considered for participation. This process takes approximately 4 weeks.

As a large group practice we employ several dentists, and the group practice owner is a contracted participating PDP provider. Why are claims for the employed dentists not being paid according to the PDP (or in-network)?
All providers who wish to participate in the Preferred Dentist Program (PDP) must apply for participation individually. Even if the primary owner(s) of a group practice are already participating PDP dentists, dentists who work for the primary owners must participate as well to receive the benefits of participation and to be considered "in-network". Payments can still be made to the group name or owner's name, but only participating PDP dentists will have claims processed "in-network." Non-PDP dentists will continue to have claims processed "out-of-network" until they are accepted for PDP participation.

How can I obtain a PDP fee schedule (table of maximum allowable charges)?
Fee schedules are given to participating Preferred Dentist Program (PDP) providers as part of their application and information packages. PDP providers may obtain a copy of their applicable fee schedule by calling MetLife's dedicated dental service line at 1-877-MET-DDS9 (1-877-638-3379) and requesting one from the automated phone system. If you are not a participating PDP provider and are interested in joining the program, you can request a PDP enrollment package that describes the program and includes a sample fee schedule for your area.

Our office has multiple dentists located and registered under one TIN, how can we ensure payments are processing under the correct provider of service?
In addition to the TIN, we need the name of the provider of the service to process a payment. Please be sure to include enough provider information (name, phone number, state) on all requests for payment.

What is "overpayment" and how does MetLife recapture funds overpaid?
Overpayments are caused/created when payment has been issued based on incorrect information. Situations that may cause an overpayment are:
      •  Wrong provider
      •  Wrong patient
      •  Services never rendered (e.g. pretreatment estimate paid as actual claim)
      •  Incorrect procedure codes submitted
      •  Incorrect dates of service
When MetLife becomes aware of the overpayment, we will take necessary steps to collect the overpayments from future payments or we will request direct reimbursement. Overpayments should be reimbursed by a personal or business check for the amount incorrectly issued with a copy of the accompanying Explanation of Benefits (EOB) Statement to the address noted on the EOB.

How do I update my Provider fee profile with MetLife?
New fee profiles should be faxed to Provider Control at 315-792-7009. You can also mail profiles to:
    MetLife Provider Control
    P.O. Box 3019
    Utica, NY 13504

How do I verify eligibility for MetLife covered patients?
You can verify eligibility of a patient through Eligibility & Plan Detail or through our automated telephone service, 1-877-MET-DDS9 (1-877-638-3379). You will need to provide the Provider's TIN and the Employee's Social Security or Identification Number to obtain this information.

What are MetLife's guidelines regarding full-time students?
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 educational institution. Ages may differ depending on certain companies' plans.

Where is the plan limitations information?
The frequency and age limitations are available on the "Benefit Levels, Frequency & Limitations" page for the specific insured. When applicable, Plan Maximum &Deductibles are available on the "Maximum & Deductibles" page for the specific insured. Other plan limitations or exclusions, such as missing tooth clause, are located on the "Plan Summary" page.

How do I know what procedures are covered for my specific patient?
This information is available on the Eligibility & Plan Detail page for your specific patient. Check your patient’s plan design.

Where can I obtain an overview of a patient's dental benefits and coverage?
Patient plan design is available in the Eligibility & Plan Detail section of this website. MetLife can fax plan design information to you using our automated telephone service. Please call 1-877-MET-DDS9 (1-877-638-3379) to obtain a Fast Fax. You will need to identify the Social Security Number of the employee in order to use this service.

If I have a patient that has a group specific fee schedule or copay schedule, how can I obtain one?
Some employers utilize reimbursement and/or copayment schedules as part of their dental benefits plan (as opposed to coinsurance percentages). MetLife does not maintain these schedules. Your patients must obtain these schedules directly from their employer (typically via the Human Resources dept.). You may obtain a patient's plan benefit information via this website or by calling 1-877-MET-DDS9 (1-877-638-3379) and requesting a Fast Fax patient plan benefit document via fax.

Does MetLife issue dental insurance cards for plan participants?
MetLife does not normally issue ID cards for individuals covered under MetLife's group dental benefit plans since eligibility and plan design information is readily available on this website and through our automated phone system at 1-877-MET-DDS9 (1-877-638-3379). However, in the case of some groups, ID cards are issued to covered employees. Please note that these ID cards are not a guarantee of eligibility, and are primarily used for easy reference to commonly needed customer service and claims information.

If you are presented with a MetLife ID card, there are no changes to how you work with MetLife. You may notice, however, that some ID cards list a unique identification number different from the patient’s social security number (SSN) you may have on file. These unique identification numbers provide plan participants and you an alternative number to use when transacting with MetLife. When presented with a unique identification number, we ask that you accept and use it as the patient’s ID number in place of his/her SSN for all transactions with MetLife. MetLife accepts these unique identification numbers for all transactions and through all MetLife systems, including MetDental.com, 1-877-MET-DDS9 (1-877-638-3379), your practice management system, or via paper.

How do I update any change in office information? For example: address, telephone number, or TIN?
There are two ways this information can be easily updated:
      •  Fax the new information to 1-859-389-6505, send information on a copy of your           letterhead
      •  Mail changes, on your letterhead, to:
          MetLife Dental PDP Network Development
          501 U.S. Hwy 22
          Bridgewater, NJ 08807

      If you need to update your office information include the following           information:

          Office Information Currently on File
          Doctors Name / Practice Name
          Street Address
          Phone Number
          Tax Identification Number (TIN)

          New Office Information
          Practice Name
          Street Address
          Billing Address
          Phone Number
          Tax Identification Number (TIN)
          Effective Date for this office
          Reason for Change

How do I change information for a practice that I recently purchased from another dentist?
By faxing the change of information to 1-859-389-6505 on letterhead. Please specify if you wish to participate in the Preferred Dentist Program (PDP) Network or if are already a participating PDP dentist

      If you need to update office information include the following information:
          Office Information Currently on File
          Doctors Name / Practice Name
          Street Address
          Phone Number
          Tax Identification Number (TIN)

          New Office Information
          Practice Name
          Street Address
          Billing Address
          Phone Number
          Tax Identification Number (TIN)
          Effective Date for this office
          Reason for Change

How can I apply for participation in the MetLife Preferred Dentist Program (PDP)?
You can request applications and participation materials by submitting an email request, click here. Or, call 1-877-MET-DDS9 (1-877-638-3379) to request a participation packet.

Where can I get a patient encounter form?
Forms can be downloaded from this website, via the Forms Library.

What is needed to submit a Dental HMO / Managed Care claim?
To submit a claim you will need the following information:
Member’s name and the member’s/subscriber’s Social Security Number (SSN) or ID Number
Procedure codes for the treatment performed
Amount billed for each procedure (if applicable)
Treating dentists office information and his/her signature

Where do I submit Dental HMO / Managed Care treatment reports, utilizations, and encounter forms?

       Completed forms and information can be mailed to:

       Dental HMO / Managed Care Referrals/Specialty Claims (including SmileSaver)
       SafeGuard Dental Claims
       P.O. Box 981987
       El Paso, TX 79998-0930

       Dental HMO / Managed Care General Dentist Claims (Including SmileSaver) - (Patient
       Treatment Reports, Utilizations, Encounters)
       SafeGuard Dental Claims
       P.O. Box 981987
       El Paso, TX 79998-0930

       UNIVERSAL Plans **Member's with the OON, or Reimbursement benefits**
       UNIVERSAL Plans
       Attn: UHC OON Claims
       4010 Boyscout Blvd. #950
       Tampa, FL 33607

How does SafeGuard coordinate benefits with other insurance plans?
Generally speaking, Dental HMO / Managed Care plans do not coordinate benefits with other insurance plans. For all other plans, please review Eligibility & Plan Detail to determine the type of coordination applied to the subscriber/employee's plan. SafeGuard will require a copy of the prior carrier's Explanation of Benefits (EOB) when applicable to consider benefit payment as secondary insurance.

What Payor ID should I use for electronic submissions?
The Payor ID for Dental HMO / Managed Care claims is CX030, the Payor ID for MetLife DPPO claims is 65978.

What version of ADA codes is SafeGuard currently recognizing?
SafeGuard uses the current ADA code version based on the date of service.

How long will it take to process payments?
The time it takes to process payments depend on the complexity of the encounter, claim or other request for payment being submitted. Most payment requests flow through our system quickly and efficiently, with most being handled within 10-15 business days.

As a contracted Dental HMO / Managed Care dentist, can we charge our "normal" fee for a dental procedure that is not covered under a patient's dental plan?
The amount you charge for a non-covered service is dictated by the terms of the member's plan. Please reference the member's Statement of Benefits for more information about allowable charges for non-covered services.

As a large group practice we employ several dentists, and the group practice owner is a contracted Dental HMO / Managed Care participating provider. Why are payments for the employed dentists not being paid according to the contract?
All providers who wish to be contracted must apply for participation individually. Even if the primary owner(s) of a group practice are already contracted, dentists who work for the primary owners must be contracted as well to receive the benefits of participation and to be considered "in-network".

Our office has multiple dentists located and registered under one TIN, how can we ensure payments are processing under the correct provider of service?
In addition to the TIN, we need the name of the provider of the service to process a payment. Please be sure to include enough provider information (name, phone number, state) on all requests for payment.

How do I verify eligibility for SafeGuard covered patients?
You can verify eligibility of a patient through Eligibility & Plan Detail

What are SafeGuard's guidelines regarding full-time students?
Many plans allow coverage on claims for dependent children between the ages of 19 and 25 if they are enrolled full-time at an approved educational institution. Ages may differ depending on certain companies' plans.

How do I know what procedures are covered for my specific patient?
This information is available on the Eligibility & Plan Detail page for your specific patient. Check your patient’s plan design.

Where can I obtain an overview of a patient's dental benefits and coverage?
Patient plan design is available in the Eligibility & Plan Detail section of this website. MetLife can fax plan design information to you using our automated telephone service. Please call 1-877-MET-DDS9 (1-877-638-3379) to obtain a Fast Fax. You will need to identify the Social Security Number of the employee in order to use this service.

How can I obtain a copy of a member's Schedule of Benefits (SOB)?
You can view or print a copy of the Schedule of Benefits (SOB) through Eligibility & Plan Detail

Where is the plan limitations information?
For Dental HMO / Managed Care plans, please refer to the Subscriber's Schedule of Benefits, specifically the "Exclusions and Limitations" pages. Check your patient's plan design.

Does MetLife issue ID cards for Dental HMO / Managed Care subscribers?
Yes. Typically, ID cards are issued for to all Dental HMO / Managed Care subscribers. However, ID cards are not required because eligibility and plan design information is readily available on this website and through our automated phone system. Please note that ID cards are not a guarantee of eligibility, and are primarily used for easy reference to commonly needed customer service and claims information.
If you are presented with an ID card, there are no changes to how you work with MetLife or SafeGuard. You may notice, however, that some ID cards list a unique identification number different from the patient's social security number (SSN) you may have on file. These unique identification numbers provide plan participants and you an alternative number to use when transacting with MetLife or SafeGuard. When presented with a unique identification number, we ask that you accept and use it as the patient’s ID number in place of his/her SSN for all transactions. We accept these unique identification numbers for all transactions and through all MetLife systems, including MetDental.com, our automated phone system, your practice management system, or via paper.

How do I update any change in office information? For example: address, telephone number, or TIN?
In order to update your information you can contact Provider Services:
Toll Free: 1-800-635-4238
By Fax: 949-425-4574

How can I apply to be a participating Dental HMO / Managed Care Dentist?
You can apply online or request applications and participation materials by phone or fax:
Phone: 1-800-635-4238
Fax: 1-949-389-9702
When faxing, please provide the following information along with your request: Dentist name, address and phone number.