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 1-800-942-0854and 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 proximately 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.
Procedures Requiring Pre-Operative PA X-rays
D2542 - D2544 Onlays
D2614 - D2642 Onlays
D2662 - D2664 Onlays
D2710 - D2799 Crowns
D2960 - D2962 Veneers
D5862 Precision Attachments
D6950 Precision Attachments
D3460 Endo Implants
D4249 Crown Lengthening
Procedures Requiring X-rays of the Entire Arch(es) and Date of Extraction
D5860 - D5861 Overdentures
D6010 - D6199 Implants/Related Service
D6210 - D6793 Bridgework
Procedures Requiring Perio Charting and Full-Mouth X-rays (if available)
D4210 - D4245 Perio Treatment
D4260 - D4268 Perio Treatment
D4274 Perio Treatment
D4341 - D4342 Scaling and Root Planing
D4381 Perio Treatment
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 dentist, can we charge our "normal" fee for a dental procedure that is not covered under a patient's dental plan?
A participating dentist should not bill amounts that are in excess of the negotiated fees that he or she has agreed to accept as payment for services to plan Beneficiaries. This rule applies even if services are not covered under the patients' 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 negotiated fee.

We are a participating group and have a new dentist joining our group, how can we ensure that his/her claims are processed according to network guidelines?*
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 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 provider. Why are claims for the employed dentists not being paid according to network guidelines?
All providers who wish to participate in the Preferred Dentist Program must apply for participation individually. Even if the primary owner(s) of a group practice are already participating 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 dentists will have claims processed as "in network". Non-participating dentists will continue to have claims processed as "out of network" until they are accepted for program participation.

How can I obtain a negotiated fee schedule (table of maximum allowable charges)?
Fee schedules are given to participating providers as part of their application and information packages. Participating 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 provider and are interested in joining the program, you can request an enrollment package that describes the program and includes a sample fee schedule for your area.

If our office has multiple dentists located and registered under one TIN, how can we ensure payments are processed 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 an overpayment, we will take necessary steps to collect the overpayment 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 and 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 patients name, sponsor name, and Sponsor Social Security for verification purposes.

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

How do I know what procedures are covered for my specific patient?
This information is available on the Eligibility and 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 and 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 sponsor in order to use this service.

* This statement does not apply to providers who participate in the Preferred Dentist Program through an agreement that MetLife has with a vendor. Providers contracted through a vendor should contact the vendor for information on applying for network participation.
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 PPO 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 or if are already a program 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?
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.
What is the TRICARE Dental Program?
Effective May 1, 2012, MetLife will become the dental carrier for the TRICARE Dental Program (TDP). MetLife will begin providing dental coverage to over 2 million family members of uniformed service active duty personnel, members of the Selected Reserve and Individual Ready Reserve, their eligible family members, and survivors.

PLEASE NOTE that the change to MetLife is for the TDP program only. The Active Duty Dental Program will still be administered by United Concordia® and the TRICARE Retiree Dental Program will still be administered by Delta Dental®.

What is the difference between CONUS and OCONUS? The TDP is divided into two geographical service areas: CONUS, inside the continental United States and OCONUS, outside the continental United States.

The TDP CONUS service area includes the 50 United States, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. The TDP OCONUS service area includes areas not in the CONUS service area and covered services provided on a ship or vessel outside the territorial waters of the CONUS service area, regardless of the dentist's office address.

How do I request electronic version of TDP Materials?
To request electronic versions of TDP materials, please email us.

How does the TDP handle alternate benefits?
In instances where the dentist and the patient select a more expensive service, procedure, or course of treatment, an allowance for an alternative treatment may be paid toward the cost of the actual treatment performed. To be eligible for payment under this provision, the treatment actually performed must be consistent with sound professional standards of dental practice, and the alternative procedure for which an allowance is being paid must be a generally accepted alternative to the procedure actually performed.

In cases where alternative methods of treatment exist, payment will be allowed for the least costly, professionally accepted treatment.

The determination that an alternate treatment is an acceptable treatment is not a recommendation of which treatment should be provided. The dentist and patient should decide which treatment to select. Should the dentist and patient decide to proceed with the more expensive treatment; the patient will be financially responsible for the difference between the dentist's fee for the more expensive treatment and the payment for the alternative service.

Note: This provision applies only when the service actually performed would be covered. If the service actually provided is not covered, then payment will not be allowed for an alternative benefit.

How can my patient continue their orthodontic treatment if they are moving?

Moving From CONUS to CONUS

If the patient transfers to a different orthodontist, the new orthodontist must submit a claim to MetLife. Payments for the new orthodontist's services will be calculated based on the remaining orthodontic maximum. It is the orthodontist's and patient's responsibility to notify MetLife if orthodontic treatment is discontinued or completed sooner than anticipated.

Moving From CONUS to OCONUS

Orthodontic care initiated in the CONUS service area may be continued OCONUS as long as the orthodontic lifetime maximum has not been met. All beneficiaries must obtain a Non-Availability and Referral Form (NARF) from their TRICARE Area Office (TAO) (or designee) before transferring to an OCONUS orthodontist. Upon issuance of the NARF and approval of the OCONUS orthodontist's treatment plan, a lump sum payment will be issued based on the patient's remaining orthodontic maximum.

Moving From OCONUS to CONUS

Orthodontic care that was provided OCONUS will typically be paid in a lump sum. If total payments made by the TDP met or exceeded the maximum, that member will be ineligible for additional claim payments by the TDP for services subsequently received in CONUS locations.

How does MetLife coordinate benefits with other insurance plans?
A TDP beneficiary may have other dental insurance. In this case, MetLife will coordinate benefits between the two dental plans.

If a beneficiary receives services that are covered under the TDP program and another dental plan, coverage and benefits are governed by coordination of benefits rules. These rules determine which plan pays benefits first and which plan pays benefits second.

Depending on the situation, the TDP may be the primary or secondary dental plan.
  • Whenever a spouse's or child's other plan is primarily a medical insurance plan, but includes a dental benefit, the plan is considered secondary. The TDP is considered primary and claims should be submitted to MetLife.
  • When a spouse has his or her own dental plan, the spouse's dental plan is considered primary and the TDP is secondary.
  • In the case of a child who is covered under two dental plans, the primary plan is typically determined by the "birthday rule," which has been established by the National Association of Insurance Commissioners. The birthday rule determines the first plan to pay benefits based on which parent's birthday falls earlier in a calendar year. For example: If the mother's birthday is January 2nd and the father's birthday is January 12th, the mother's dental plan is considered primary and would pay benefits first.
  • An exception to this birthday rule occurs if the other dental plan uses the "gender rule". The gender rule specifies that the male parent's dental plan is considered the primary plan. If the other dental coverage uses the gender rule in determining coordination of benefits, MetLife will defer to the gender rule and consider the male parent's dental plan as the primary plan.
  • In situations where the natural parents are not married and there are two dental plans, MetLife considers the insurance plan of the parent with custody to be the primary plan. If the parent with custody has remarried, the stepparent's plan will pay before the plan of the parent without custody. An exception to this rule occurs when there is a court decree specifying which parent is responsible for insurance coverage.
Claims should always be filed with the primary plan first. After payment has been received from the primary plan, the claim can be filed with the secondary plan. When submitting a claim to MetLife for coordination under the TDP as secondary coverage, a copy of the primary insurance plan's DEOB must be attached.

The primary plan pays benefits without regard to the secondary plan. When TDP coverage is secondary, the plan pays for covered services which have not been paid by the primary plan. The TDP will coordinate with the primary insurance carrier and pay for TDP covered services according to TDP provisions and limitations. Payment as the secondary carrier will not exceed the provider charge or the amount the TDP would have paid as the primary carrier, whichever is less. In no instances should the total payments for a service by the primary and secondary carrier exceed the dentist's charge.

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. In addition, for the TRICARE Dental Program, please refer to the TRICARE Dental Program Benefits Booklet.
What ID should I use to service TRICARE Beneficiaries?
To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of the Department of Defense Beneficiary Number found on their ID Card. View a Sample ID Card.

Where can I get a TRICARE Dental Program claim form?
TRICARE Dental Program claim forms can be downloaded from this website. If you are servicing a member within the CONUS service area, submit the CONUS Claims Submission Document. If you are servicing a member OCONUS, outside of the United States, submit the OCONUS Claims Submission Document.

Where do I submit claims and requests for pretreatment estimates?
If you are servicing TRICARE Dental Program (TDP) plan participants within the Continental United States (CONUS) you can file claims electronically through a claims clearinghouse or through paper and fax. To submit a CONUS claim, please follow the instructions on the CONUS claim form. These claims should be sent to:

MetLife TRICARE Dental Program
PO Box 14181
Lexington, KY 40512

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 14 calendar 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.

What are the CONUS maximums?
Annual Maximum Benefit
There is a $1,300 annual maximum benefit per beneficiary per plan year for non-orthodontic services. Each plan year begins May 1st and ends April 30th. Payments for certain diagnostic and preventive services are not applied against the annual maximum. To view current maximum information, access the Eligibility and Plan Detail section of this website.

Lifetime Maximum Benefit for Orthodontic Treatment
For orthodontic treatment, there is a $1,750 lifetime maximum benefit per beneficiary. Orthodontic diagnostic services will be applied to the $1,300 dental program annual maximum. To view current maximum information, access the Eligibility and Plan Detail section of this website.

Accidental Annual Maximum Benefit
In addition to the annual maximum, there is a $1,200 accidental annual maximum (applicable to dental care provided due to an accident). An accident is defined as an injury that results in physical damage or injury to the teeth and/or supporting hard and soft tissues from extra oral blunt forces and not due to chewing or biting forces.

As a participating dentist, can we charge our "normal" fee for a dental procedure that is not covered under a patient's dental plan?
A participating dentist should not bill amounts that are in excess of the negotiated fees that he or she has agreed to accept as payment for services to plan Beneficiaries. This rule applies even if services are not covered under the patients' 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 negotiated fee.

We are a participating group and have a new dentist joining our group, how can we ensure that his/her claims are processed according to network guidelines?*
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 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 provider. Why are claims for the employed dentists not being paid according to network guidelines?
All providers who wish to participate in the Preferred Dentist Program must apply for participation individually. Even if the primary owner(s) of a group practice are already participating 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 dentists will have claims processed as "in network". Non-participating dentists will continue to have claims processed as "out of network" until they are accepted for program participation.

How can I obtain a negotiated fee schedule (table of maximum allowable charges)?
Fee schedules are given to participating providers as part of their application and information packages. Participating 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 provider and are interested in joining the program, you can request an enrollment package that describes the program and includes a sample fee schedule for your area.

If our office has multiple dentists located and registered under one TIN, how can we ensure payments are processed 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 an "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 an overpayment, we will take necessary steps to collect the overpayment 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 and 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 patients name, sponsor name, and Sponsor Social Security for verification purposes.

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

How do I know what procedures are covered for my specific patient?
This information is available on the Eligibility and 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 and 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 sponsor in order to use this service.



* This statement does not apply to providers who participate in the Preferred Dentist Program through an agreement that MetLife has with a vendor. Providers contracted through a vendor should contact the vendor for information on applying for network participation.
What ID should I use to service TRICARE Beneficiaries?
To best service TRICARE beneficiaries, please use the patient's Social Security Number or the first nine digits of the Department of Defense Beneficiary Number found on their ID Card. View a Sample ID Card.

What are the OCONUS Referral Procedures for Orthodontic Services?
Before any orthodontic care, the TAO, overseas uniformed services dental treatment facility (ODTF), or designated OCONUS Points of Contact (POCs), must issue an initial Non-Availability and Referral Form (NARF) for an orthodontic examination and treatment plan authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist.

After the initial exam is completed, the initial NARF, the claim form, and the provider's bill for the initial exam and treatment plan should be sent to MetLife for payment.

If an estimate is submitted with all the necessary information along with an approved NARF, when the actual treatment is rendered, MetLife does not require submission of a second NARF. The only time MetLife requires a second NARF is when the provider only sends us the exam/workup for orthodontics without reference to future treatments. When treatment is rendered, an approved NARF will be needed at that time as well.

Note: Patients are recommended to seek a predetermination of payment from MetLife for all orthodontic and complex dental treatment plans. To submit the predetermination request, complete a claim form and include a statement from the orthodontist identifying the total cost of all treatment needed. MetLife will review and provide the patient with a summary of the covered costs. Patients have a $1,750 lifetime orthodontic benefit.

After receiving the predetermination, the sponsor may submit the second NARF (approving the comprehensive orthodontic treatment), the claim form, and the dentist's bill for full orthodontic treatment to MetLife for payment.

What is the Orthodontic Cost Share for OCONUS Beneficiaries?
For orthodontic services received by Command Sponsored members, claims are paid as follows:
  • Member pays cost share based on lesser of dentist's actual charge or MetLife's allowed fee
Although OCONUS coverage is available for National Guard, Reserve, Individual Ready Reserve (IRR) family members and IRR (other than Special Mobilization Category) members, such member's claims (as well as any other member who is not Command Sponsored) are administered based upon the CONUS guidelines for out of network care. The $1,750 lifetime maximum applies, the CONUS cost shares apply, and the member is responsible for the dentist's or orthodontist's fee in excess of MetLife's allowed fee.

What information is available for Orthodontic Payments for OCONUS Beneficiaries?
Payment for orthodontic treatment initiated in the OCONUS service area for Command Sponsored members will be issued in one lump sum, subject to approval of the OCONUS orthodontist's treatment plan. MetLife will make one payment that includes the portion of the claim reimbursed by the government for Command Sponsored beneficiaries. The remaining liability is the responsibility of the beneficiary. That liability for a Command Sponsored beneficiary should be limited to the 50% cost share of the allowed fee.

If a member exceeds the age limitation (as described under the Orthodontic "Eligibility" section of the TRICARE Dental Program Benefits Booklet) during the course of orthodontic treatment, MetLife's payment will be calculated based on the months of actual eligibility. All charges incurred after the loss of eligibility will be the member's financial responsibility.

Sponsors and family members contemplating orthodontic care in the OCONUS service area are cautioned that, because OCONUS dentists are paid in a lump sum amount, their $1,750 lifetime maximum may be fully exhausted when they return to the CONUS service area, regardless of whether or not the orthodontic care was completed.

When using a TRICARE OCONUS Preferred Dentist (TOPD), please note that MetLife pays the orthodontist directly for services. Also, please only pay the applicable cost share.

Where can I get a TRICARE Dental Program claim form?
TRICARE Dental Program claim forms can be downloaded from this website. If you are servicing a member within the CONUS service area, submit the CONUS Claims Submission Document. If you are servicing a member OCONUS, outside of the United States, submit the OCONUS Claims Submission Document.

Where do I submit claims and requests for pretreatment estimates? If you are servicing a TRICARE Dental Program (TDP) plan participant outside of the continental United States (OCONUS) claims can be filed through paper or fax only. To submit an OCONUS claim, please follow the instructions on the OCONUS claim form. These claims should be sent to:

MetLife TRICARE Dental Program
PO Box 14182
Lexington, KY 40512

Please note there are specific XRAY and attachment guidelines for TRICARE claims submissions. Please review the electronic attachment information below prior to submitting a claim.

For dental care provided in OCONUS locations, if the claim form to be submitted does not already provide the following information, please be sure to include:
  • Date(s) of service
  • Provider name, address, phone number
  • Specific problem encountered
  • Procedure code(s)
  • Specific tooth/teeth treated for each service performed, where appropriate
  • Total charges
  • If a procedure code is not provided on the claim form, a complete description of the service performed, including applicable tooth number(s), should be provided, where appropriate
For MetLife to process claims, the following information is needed:
  • A completed claim form
  • A dentist bill or statement of charges. If the specific service(s) provided is repeated on the claim form, a separate office bill is not needed
  • Non-Availability and Referral Form (NARF) for Orthodontia
How will claims be paid for OCONUS Beneficiaries?
Within OCONUS locations, some dentists may require beneficiaries to pay for services before they are rendered.

Orthodontia claims in OCONUS locations will typically be paid directly to the dentist. For services other than Orthodontia, MetLife will make payment for covered services to either the dentist or beneficiary, depending on which party submitted the claim. In cases in which the dentist submitted the claim, MetLife will issue payment to the dentist and a Dental Explanation of Benefits (DEOB) to both the dentist and the beneficiary. In cases in which the beneficiary forwarded the claim, MetLife will issue payment and a DEOB to the beneficiary. If the beneficiary submits the claim and states that payment should be made directly to the dentist, the beneficiary must sign the portion of the claim form that assigns benefits to the dentist. If MetLife is unable to determine which party forwarded the claim, payment will be issued to the dentist.

All payments issued to a dentist from the OCONUS service area will be paid in foreign currency, subject to the availability of these currencies through recognized U.S. banking institutions. All claims submitted by beneficiaries will be paid in U.S. dollars.

After a foreign draft (in foreign currency) has been issued, payment will not be changed to U.S. dollars. All payments requiring conversion to foreign currency will be calculated based on the exchange rate in effect on the last date of service listed on the claim or bill.

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 14 calendar days. If additional information is needed for a claim, it may take up to 30 days.

What is the maximum for OCONUS services?
The maximums for the OCONUS service area are the same as the CONUS service area. In the OCONUS service area, the government will pay for any valid costs in excess of MetLife's allowable charge (allowed fee) up to the billed charge for all enrollees except Selected Reserve and IRR family members and IRR (other than Special Mobilization category) members and/or those who are not command sponsored.

The government will not pay for the portion of the enrollees maximum that has already been paid by MetLife nor will the government pay for any costs once the maximum has been met.

Please note, that only MetLife's allowed fee (or the dentist's actual charge if lower) less the applicable cost share is applied against the maximum.

What are the OCONUS TDP COST SHARES?
Prior to submitting a claim to MetLife for payment of dental services, you may collect patient cost shares, if applicable, from the TDP enrollee. Cost shares will vary depending on the patient's "command sponsored" versus "non-command sponsored" status.
  • To ensure that the correct patient cost share is collected, it is best to request a pre-determination for dental services from MetLife for prosthetic cases or complex cases costing over $1,300. We recommend submitting the Pretreatment estimate request to MetLife for predetermination prior to beginning dental treatment.
  • Command-sponsored enrollees have cost shares for 3 types of treatment:
    • Other Restorative Services (i.e. Crowns, Onlays, Veneers, etc)
    • Prosthodontics
    • Orthodontics
    • Implant placement and restoration
  • Non-command-sponsored enrollees have cost shares for all treatment with the exception of diagnostic and preventive services:
    • Applicable cost shares outlined in the TRICARE Dental Program Benefit Booklet
    • Non-command sponsored enrollees are covered by the payment rules that exist 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
    • Neither MetLife nor the government take responsibility for payments owed to the provider by the patient or sponsor. For example:
      • Treatment that is not a part of TDP benefits
      • The maximum yearly benefit of $1,300 has been reached
      • Patient's cost shares
Is there an OCONUS PDP Network?
No, however there is a preferred dentist listing of TRICARE OCONUS Preferred Dentists (TOPD).

As a TOPD, you will be providing professional dental services to over 2 million TRICARE Dental Program (TDP) beneficiaries which include family members of uniformed service Active Duty personnel, and members of the Selected Reserve and Individual Ready Reserve and their eligible family members. Requirements for designation include:
  • TOPDs to only require the TDP enrollee to pay their applicable cost shares at the time of the appointment
  • TOPDs will complete and submit claim forms for the TDP enrollee
  • TOPDs invoice MetLife directly for the TDP's share of the bill
  • Provide English language services
  • Follow appropriate sterilization practices
How do I check TRICARE Benefit Plan specifications for OCONUS Beneficiaries?
The TRICARE Dental Program Benefit Booklet is an essential guide to the TDP benefits. Access the TRICARE Dental Program Benefit Booklet or request a copy via by telephone at 855-MET-TDP2 (855-638-8372).

Who is eligible for overseas dental benefits under the TDP?
All enrolled beneficiaries are eligible for dental care both inside the continental United States (CONUS) and outside the continental United States (OCONUS). However, only command- sponsored members may pay the OCONUS cost- shares. All others will pay cost-shares as shown in Section 4 of the TRICARE Dental Program Benefit Booklet.

How do I verify eligibility for OCONUS Beneficiaries?
Only patients that are enrolled in the TDP and are "command-sponsored" are eligible for overseas benefits under the TDP. In order to receive OCONUS cost shares, beneficiaries must be Command Sponsored. TDP "non-command sponsored" enrollees are eligible for TDP dental benefits, however, they have different patient cost shares. You need to confirm three things - enrollment, command-sponsorship, and amount of benefit the patient has remaining through Metropolitan Life Insurance Company (MetLife) in the United States before providing care. You will need:
  • Patient's name
  • Sponsor's Name
  • Sponsor's Social Security Number
Where is the plan limitations information?
For detailed frequency and age limitations for the TRICARE Dental Program please refer to the TRICARE Dental Program Benefits Booklet.

How do I know what procedures are covered for my specific patient?
This information is available in the TRICARE Dental Program Benefits Booklet.

Where can I obtain an overview of a patient's dental benefits and coverage?
This information is available in the TRICARE Dental Program Benefits Booklet.
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