Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Why? 0000016913 00000 n
Applicable FARS/DFARS apply. To change your PCD, log in to your member website. Provider Quick Reference Guide Please log in to your secure account to get what you need. Contact Us. Aetna Inc. and its affiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. 4792 0 obj
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You can view and print your ID card from your member website. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). Any languages spoken in offices indicated in this search are self-reported. For information related to withdrawal management services (previously detox), please see the agency's inpatient hospital guide. Or it will be a flat dollar amount (copay). While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. WebYikes, something went terribly wrong!!! Compare dental plans | Washington State Health Care Authority Stay up-to-date with rate andbilling changes, and ProviderOne system changes. Discontinued 3/31/2013. 0000050717 00000 n
20% PPO and out-of-state; 30% non-PPO. Payments Information Visit our Document submission cover sheets page to find the barcode cover sheets required with additional documentation. G
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Illinois DMO is not an HMO. Call Customer Service at Benefits provided by SafeGuard Health Plans, Inc., a MetLife company. endstream
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required under the federal Americans with Disabilities Act of 1990 &~gHE}7m3_I<3I$$MYK2([{/)yRX-aE'[;"%[btE*4AwY+B1]B.. We encourage you to select a primary dentist at the time of enrollment. 0000035971 00000 n
See Physician-related/professional services for information regarding vision exams and related services. You can also contact Member Services to determine if they are eligible under your DMO plan. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Yes, but some plans may limit the benefit to certain teeth. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. WebMetLife has the largest range of dental insurance plans and providers among dental insurance organizations. There are several types of coordination of benefits provisions. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. 2023 to February 25, 2023 Telemedicine billing guide, November 2, 2022 to December 31, 2022 Telemedicine billing guide, August 1, 2022 to present Apple Health (Medicaid) physical health audio-only procedure codes, January 1, 2023 to present - Apple Health (Medicaid) audio-only behavioral health codes, August 1, 2022 to December 31, 2022 Apple Health (Medicaid) audio-only behavioral health codes, June 28, 2022 to July 31, 2022 Telehealth services billing guide audio only supplement, May 12, 2023 to present - Clinical policyfor COVID-19, August 1, 2022 to May 11, 2023 Apple Health (Medicaid) clinical policy and billing for COVID-19, July 22, 2022 to July 31, 2022 Apple Health (Medicaid) clinical policy and billing, February 1, 2022 to July 21, 2022 Apple Health (Medicaid) clinical policy and billing, January 1, 2022 to January 31, 2022 Apple Health (Medicaid) clinical policy and billing, View all clinical policy and billing FAQs, June 6, 2020 to December 31, 2021 Apple Health (Medicaid) telemedicine/telehealth brief, May 10, 2020 to June 6, 2020 Apple Health (Medicaid) telemedicine/telehealth brief, April 29, 2020 to May 9, 2020 Apple Health (Medicaid) telemedicine/telehealth brief, May 12, 2023 to present - Apple Health (Medicaid) behavioral health policy and billing, August 1, 2022 to May 11, 2023 Apple Health (Medicaid) behavioral health policy and billing, February 1, 2022 to July 31, 2022 Apple Health (Medicaid) behavioral health policy and billing, April 29, 2021 to January 31, 2022 Apple Health (Medicaid) behavioral health policy and billing, View all behavioral health policy and billing FAQs, July 22, 2022 to present Apple Health (Medicaid) ABA policy and billing, February 1, 2022 to July 21, 2022 Apple Health (Medicaid) ABA policy and billing, January 1, 2022 to January 31, 2022 Apple Health (Medicaid) ABA policy and billing, July 22, 2022 to present Apple Health (Medicaid) FAQ for diabetes education providers, February 1, 2022 to July 21, 2022 Apple Health (Medicaid) FAQ for diabetes education providers, January 1, 2022 to January 31, 2022 Apple Health (Medicaid) FAQ for diabetes education providers, View all FAQs for diabetes education providers, May 3, 2020 to present Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic, November 20, 2020 to May 2, 2021 Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic, October 1, 2020 to November 19, 2020 Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic, View all home health services billing and policy FAQs, July 22, 2022 to present Telehealth requirements for physical, occupational and speech therapy, February 1, 2022 to July 21, 2022 Telehealth requirements for physical, occupational and speech therapy, January 1, 2022 to January 31, 2022 Telehealth requirements for physical, occupational and speech therapy, View all telehealth requirements for physical, occupational, and speech therapy, January 1, 2022 to present Telehealth services in long term care facilities and skilled nursing facilities, May 3, 2021 to December 31, 2021 Telehealth services in long term care facilities and skilled nursing facilities, October 1, 2020 to May 2, 2021 Telehealth services in long term care facilities and skilled nursing facilities, View all Telehealth requirements for LTC and SNF, February 1, 2022 to present Family planning only billing guide telemedicine/telehealth, January 1, 2022 to January 31, 2022 Family planning only billing guide telemedicine/telehealth, May 3, 2021 to December 31, 2021 Family planning only billing guide telemedicine/telehealth, April 1, 2023 to present TransHealth program billing guide, January 1, 2023 to March 31, 2023 TransHealth program billing guide, January 1, 2023 to present TransHealth fee schedule, April 1, 2023 to present Tribal health billing guide, January 1, 2023 to March 31, 2023 Tribal health billing guide, October 1, 2022 to December 31, 2022 Tribal health billing guide, View all Tribal Health Program billing guides, January 1, 2023 to present Tribal health program fee schedule, January 1, 2022 to December 31, 2022 Tribal health program fee schedule, October 1, 2021 to December 31, 2021 Tribal health program fee schedule, July 1, 2022 to present Vision hardware billing guide, January 21, 2022 to June 30, 2022 Vision hardware billing guide, January 1, 2022 to January 20, 2022 Vision hardware billing guide, Guidance for hospitals in billing MCOs for services provided to newborns, January 1, 2023 to present Refer to the. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. endstream
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Questions may be directed to Humana provider relations by calling 1-800-626-2741, Monday Friday, 8 a.m. 5 p.m., Central time. The PCD has primary responsibility for managing your dental care. My Dental PPO - MetLife WebWhen is periodontal maintenance covered?
Finding the right dentist is easy with the MetLife dental network, which includes over 146,000 providers Visit providers in or out of network with our flexible plans Members benefit from our negotiated fees, which are typically 30-45% less than average Some Quick Facts About MetLife While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. %PDF-1.7
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CPT is a registered trademark of the American Medical Association. Periodontal maintenance is for patients whove previously had periodontal treatment. 0000021213 00000 n
How do I notify SEBB that my loved one has passed away? You can see if your plan has a work-in-progress exclusion. $10 to $50 to extract a tooth. Signing up is simple and free. The AMA is a third party beneficiary to this Agreement. It is only a partial, general description of plan or program benefits and does not constitute a contract. TmEg=boq1c8-,4%n (x@q U?eVzfK@X^=|?UOeq}:C |zYlK$"91q''o%$D?('N.. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. All Rights Reserved. Yes. Select "Search" to go to the Find a Dentist tool, choose your network and enter your ZIP code for a list of participating dentists. The MetLife dental network includes thousands of providers, so finding the right dentist is easy. Our plans give you the flexibility to visit providers in or out-of-network. 3 Most cleanings and exams are covered 100%. Just go to the Apple App Store or Google Play Store.
Find a dental plan thats right for you and your family, based on your needs and budget. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Verify the spelling of the provider's last name or office name. I was billed more than the standard $150 co-payment for a crown. 0000036485 00000 n
WebYou may choose one of four dental plans, offered by SafeGuard, a MetLife Company and Metropolitan Life. Ooops!!! - MetLife Provider billing guides and fee schedules - Washington !f"UF =,T).ts If you do not intend to leave our site, close this message. Plus, you'll enjoy: More than 400 covered services 2. CPT only copyright 2015 American Medical Association. hb```, cb.0800(_^Xf5VtUm]81JRtsFGIGcSPaf@Z F
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Aetna Inc. and itsitsaffiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Download the Pharmacy Information Authorization form (13-835A). cy Please contact Member Services. 0000072009 00000 n
Metlife - Member Dental Plan Benefits - Member Benefits See Physician-related/professional services.). {YO2GMP!BJMP(!/(q@>6 0 1
Copyright 2015 by the American Society of Addiction Medicine. Federal Dental Insurance | MetLife FEDVIP 2023 Check your Aetna Summary of Benefits. 0000050892 00000 n
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Orthodontia (adults and children) You pay 50% of covered services. hW[O8+~ If not, we will pay as the secondary payor. You must contact us. This Agreement will terminate upon notice if you violate its terms. For telehealth policies and FAQs, see Telehealth on this page. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. WebWorldwide dental coverage and plans with no deductible New Hires have 60 days to choose benefits. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. Orthodontia. January 1, 2023 to present Dental program fee schedule (updated January 26, 2023) 0000035839 00000 n
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Verify the spelling of the street name or city. Hn@})R$R(8I1$o0Z?IT @m$,RRW$_yV? 0000000016 00000 n
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7p\y D2a\&bh1hq{.uNj`)9T@*pU&T!Bz $2ToWIGtfN.[4y7n1MDP0j=g*E^ X2SYJsOJ=I!J]D]KRihmOS-f&nR#wa{:f$f? WebThe sequestration reduction amount for each affected claim will be identified on the explanation of remittance healthcare providers receive from Humana. We need to authorize the use of a different provider before treatment. Dental For other specialists, a referral may be necessary. Treating providers are solely responsible for medical advice and treatment of members. P|!(}!h}qsPq!F#($FikLuJs?nSG^w;jp*B3&x!W x}k}l~'W)+~KZnsN1MVqy G8O,'"Gg Q
BG[uA;{JFj_.zjqu)Q Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Download the free app today. Use the billing guides and fee schedules to find rate information and the ProviderOne Billing and Resource Guide to walk through the claims process. The secondary plan acts like a supplement to the primary plan. ), If you choose a new PCD on the sixteenth day of the month or later, the change will go into effect two months afterward. Fee Schedule For fee schedule and rate questionsEmail:ProfessionalRates@hca.wa.gov, For all other provider questionsMedical Assistance Customer Service Center (MACSC)Online: secure formPhone: 1-800-562-3022, Website feedback: Tell us how were doing, Copyright 2023 Washington Health Care Authority, I help others apply for & access Apple Health, Apple Health for Workers with Disabilities (HWD), Medically Intensive Children's Program (MICP), Behavioral health services for prenatal, children & young adults, Wraparound with Intensive Services (WISe), Behavioral health services for American Indians & Alaska Natives (AI/AN), Substance use disorder prevention & mental health promotion, Introduction overview for general eligibility, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services & supports (LTSS) manual, Medical plans & benefits (including vision), Life, home, auto, AD&D, LTD, FSA, & DCAP benefits. WebProvider Agreement Fee Schedules (Please reference the fee schedule noted in your provider agreement, and if appropriate, check the CMS website to review the fee schedule for Medicaid and Medicare Advantage health plans.) For the Federal Dental Plans, the MetLife fee will prevail regardless of the primary carrier status. 1Birthday refers only to the month and day in a calendar year, not the year in which the person was born. 2 This rule is referred to as the birthday rule. Dental The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). Go to the American Medical Association Web site. WebOral surgery. Treating providers are solely responsible for dental advice and treatment of members. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. Aetna Dental 0000048067 00000 n
Applicable FARS/DFARS apply. Please see your plan documents. You may still elect to receive services from a non 0000001499 00000 n
L0621014064[exp0622][All States]. Orthodontic treatment from a participating provider doesnt require referrals. and Section 504 of the Rehabilitation Act of 1973. By contacting the Payor, a provider can identify which network fee schedule is being utilized for claim reimbursement and verify participation status with the plan. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. These rules determine You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. No fee schedules, basic unit, relative values or related listings are included in CPT. endstream
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MetLife Dental Comparison Chart Your plan may have a coordination of benefits provision. endstream
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Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 'u s1 ^
If this occurs, please refer to the most recent guide. Contact Member Services if you have questions. Altamonte Springs dentists Boca Raton dentists Clearwater dentists Coral Gables dentists Coral Springs dentists Daytona Beach dentists Delray Beach dentists Englewood dentists Fort Lauderdale dentists Gainesville dentists Grove City dentists This SCHEDULE OF BENEFITS lists the Covered Services available to You and Your Dependents under Your dental plan, as well as Your and Your Dependents costs for each Covered Service. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. (Effective October 1, 2015 this guide was merged into the physician-related services/health care professional services billing guide.