METLIFE INCREASES EXAMS... - 04/12/2001
But forgets to change its computers. Dental Systems, a company providing comprehensive dental benefit information to dental offices in the state of Texas, reports that MetLife made an across-the-board policy decision regarding exams last spring. In April of 2000, MetLife decided to allow a limited oral evaluation (D0140) in addition to the two periodic evaluations (D0120) allowed under most of its dental plans. As you know, many dental plans only allow two evaluations per year, regardless of the type.
Unfortunately, MetLife forgot to change its computer systems to reflect the additional D0140 benefits and claims have been rejected until it was called to their attention recently. When Dental Systems called MetLife to ask why the limited evaluation claims were being denied even after the policy changed, MetLife realized it had not updated its computer systems to reflect the change in policy. When asked, MetLife said it will not automatically reprocess all D0140 claims since last April even though they were processed incorrectly. MetLife will only reprocess a claim if the patient or provider calls it to their attention. So if you have a patient whose limited oral evaluation was rejected after April, 2000 due to an exam frequency limitation, call MetLife to reprocess the claim.