In Illinois, DMO plans provide limited out-of-network benefits. Unlisted, unspecified and nonspecific codes should be avoided. Network dentists are paid contracted fees. When billing, you must use the most appropriate code as of the effective date of the submission. HMo0?v:JzXc/Y~ 4$8#27t9hkG~NMf]n+tAk Wh._AkJ~Mm1.O]f.ixk% (ABT iE%Jz,3X6#N]W_Q.v(>2(0CH*vy!f( Hn@})R$R(8I1$o0Z?IT @m$,RRW$_yV? Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). 0000029561 00000 n Information is believed to be accurate as of the production date; however, it is subject to change. WebYikes, something went terribly wrong!!! endstream endobj 780 0 obj <>/Metadata 30 0 R/Pages 777 0 R/StructTreeRoot 55 0 R/Type/Catalog/ViewerPreferences 798 0 R>> endobj 781 0 obj <>/MediaBox[0 0 612 792]/Parent 777 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 782 0 obj <>stream Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. Oral surgery You pay 20% of covered services for basic surgery; 50% of covered major surgery. Some subtypes have five tiers of coverage. endstream endobj 4796 0 obj <>stream The DMO plan doesnt have any deductibles or annual maximums. As a MetLife Vision customer you can access language 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. WebYou can obtain an updated procedure charge schedule for your area via fax by dialing 1-800-942-0854 and using the MetLife Dental Automated Information Service. When your st dentisuggests treatment, have him or her send a claim form, along with the proposed mtreneatt plans and supporting documentation to MetLife. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. 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.
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