2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 94
DENTAL AND VISION CLAIM AND APPEAL PROCEDURES
You will receive an Employee insurance card which will contain important information, including claim filing
directions and contact information. The Employee insurance card you received for your Medical Plan also includes
the Dental and Vision Plans showing your Participating Provider Network and the Medical Management
Administrator.
At the time you receive treatment, show the Employee insurance card to your provider of service. In many cases,
your provider will file the claim for you. You may also file the claim yourself by submitting the required information
to
Meritain Health, Inc.
P.O. Box 853921
Richardson, TX 75085-3921
(800) 925-2272
All claims under the Dental/Vision Plan will be “post service claims.” A “post service claim” is a claim for a benefit
under the Dental/Vision Plan after the services have been rendered. Post service claims must include the following
information in order to be considered filed with the Dental/Vision Plan:
(1)
The date of service;
(2)
The name, address, telephone number and tax identification number of the provider of the services or
supplies;
(3)
The place where the services were rendered;
(4)
The diagnosis and procedure codes;
(5)
The amount of charges (including Network repricing information);
(6)
The name of the Dental/Vision Plan;
(7)
The name of the Covered Employee; and
(8)
The name of the patient.
A call from a provider who wants to know if an individual is covered under the Dental/Vision Plan or if a certain
procedure or treatment is a Covered Expense before the treatment is rendered, is not a “claim” since an actual
written claim for benefits is not being filed with the Dental/Vision Plan. Likewise, presentation of a prescription to
a pharmacy does not constitute a claim.
Timely Filing
All claims must be filed with the Claims Administrator within 1 year following the date services were Incurred.
Claims filed after this time period will be denied.
For Dental and Vision Claims
Meritain Health
P.O. Box 853921
Richardson, TX 75085-3921
800-925-2272
90