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MetLife requires electronic reimbursement

ADA effort allows dentists to opt out if technology unavailable

October 03, 2016

By Kelly Soderlund

A new MetLife policy requires dentists to receive their reimbursements electronically, but after the ADA contacted the company, it clarified its position that dentists can opt out if they do not have the technology available.

MetLife mailed participating dentists a letter on Aug. 15 notifying them that, as of Sept. 15, electronic funds transfer will be the only method of reimbursement and that dentists are required to enroll before that date. The company contended that receiving reimbursements electronically was faster and more secure than the paper method.

By enrolling for electronic funds transfer, dentists will also stop receiving explanation of benefits statements within 31 days. Dentists can view EOBs online by registering for MetLife's website.

After receiving the letter, the ADA Practice Institute began receiving calls from members questioning the policy change. ADA staff immediately contacted MetLife relaying the concerns, specifically that some dental offices use practice management systems that are not fully equipped to handle end-to-end electronic claims processing.

"The ADA understands the benefits that electronic funds transfer payments can offer a dental practice," said Dr. Ronald Riggins, chair of the ADA Council on Dental Benefit Programs. "However, dental offices have reported problems matching electronic payments to explanation of benefits statements, ensuring that accurate electronic deposits are made and reconciling electronic funds transfer deposits into practice management software. Until these issues are resolved, dentists should have the freedom to choose whether they want to receive electronic funds transfer payments or paper checks."

MetLife responded to the ADA's inquiry and agreed that some offices may not yet be equipped to handle this change and those who can't are able to choose to opt out of receiving reimbursements electronically.

"A growing number of our providers appreciate the speed with which reimbursements are received and the fact that their office staff does not have to deal with the time and hassle of paper, and can devote more time to patient care," said David Hammarström, MetLife spokesman. "We expect that at a future date the entire industry will go 100 percent paperless for claims and reimbursements, but we recognize that there are some offices that are not yet technologically set up to accommodate electronic funds transfer. We are glad to work with them to determine their eligibility to opt out of electronic funds transfer."

Aetna and Regence have implemented similar policies for their providers.

More and more customers are starting to prefer the use of electronic funds transfer as a payment method from insurance carriers, said Zack Church, product analysis manager for Henry Schein Practice Solutions.

"Dentists particularly want this if their practice or organization is large and has a high volume of claims or the insurance carrier is a large one that's widely used, resulting in multiple bulk payments from those payers on a consistent basis," Mr. Church said.

"However, just because an insurance carrier is able to provide reimbursement in the form of electronic funds transfer, it doesn't necessarily mean that they are also set up to provide electronic remittance advice. When an insurance carrier is in this situation, they really only provide a portion of a fully electronic solution. A fully electronic solution would provide not only the ability for a claim to be submitted electronically and an electronic funds transfer to be used as a means for reimbursement, but also would include the ability for the insurance carrier to send the electronic remittance advice data."

Dr. Riggins noted that the Council on Dental Benefit Programs will discuss this issue with the National Association of Dental Plans and more information will be available in the near future.