MetLife Dental Payment Reconciliation: A Complete Walkthrough

MetLife deposited $11,287.93 into your account. The bank description says "METLIFE." Now you need to figure out which patients, which procedures, and whether you were paid correctly.

Understanding MetLife Dental Payments

MetLife is one of the largest dental insurance providers in the United States, covering millions through employer-sponsored plans. For many dental practices, MetLife represents a significant portion of insurance revenue.

MetLife payments follow standard industry patterns: claims are processed, payments are sent as lump sums covering multiple patients, and Electronic Remittance Advice explains what was paid. However, MetLife has its own portal, ERA format, and quirks that affect reconciliation.

This guide walks through MetLife-specific reconciliation, covering portal navigation, ERA matching, and common issues unique to this payer.

How MetLife Payments Arrive

Electronic Funds Transfer (EFT)

Most MetLife payments arrive via EFT direct deposit.

Bank description: Typically appears as "METLIFE" or "MET LIFE" with a trace number.

Timing: Payments usually deposit 1-2 business days after MetLife releases them.

EFT enrollment: You must enroll through the MetLife portal or your clearinghouse to receive electronic payments.

Paper Checks

Practices not enrolled in EFT receive paper checks.

Delivery: Mailed with accompanying EOB documentation.

Processing time: Slower than EFT, with mail delay adding several days.

Recommendation: Enroll in EFT for faster, more reliable payment receipt.

Virtual Credit Cards

MetLife may offer virtual credit card payments. Evaluate carefully before accepting.

Processing fees: Virtual cards incur credit card processing fees of 2-3%.

Recommendation: Most practices should decline virtual cards and request EFT to preserve the full payment amount.

Navigating the MetLife Provider Portal

Portal Access

MetLife's provider portal is called MetLife eDental.

URL: https://edental.metlife.com

Registration requirements:

• Tax ID number
• NPI number
• Practice information
• Authorized user details

Multiple users: Create accounts for staff who need access, with appropriate permissions.

Finding Payment Information

Once logged in, locate payment and remittance data.

Navigation path: Claims & Payments → Payment History or Remittance Search

Search options:

• Payment date range
• Check/EFT number
• Payment amount
• Patient name
• Claim number

Downloading ERAs

MetLife provides ERAs through the portal.

To access:

1. Navigate to the payment you need
2. Select "View Remittance" or "ERA Download"
3. Choose your preferred format (835 or PDF)

Bulk downloads: Download multiple ERAs for a date range to process together.

ERA Delivery Alternatives

MetLife ERAs can also arrive through:

Clearinghouse: Configure your clearinghouse to receive MetLife ERAs automatically. This is often most efficient for practices using auto-posting.

Direct feed: Larger organizations may establish direct ERA connections.

Verify your clearinghouse is receiving MetLife ERAs to avoid missing documentation.

Matching MetLife EFTs to ERAs

Step 1: Identify the Deposit

Locate the MetLife deposit in your bank account.

Record:

• Exact deposit amount
• Deposit date
• Trace number (if visible in description)

Step 2: Search for Matching ERA

Find the ERA that corresponds to your deposit.

In clearinghouse:

• Search by date range (1-3 days before deposit)
• Search by exact amount
• Filter by payer (MetLife)

In MetLife portal:

• Use payment search
• Enter amount and date range
• Check trace number if available

Step 3: Verify the Match

Confirm the ERA and deposit correspond.

Verification checks:

• ERA total exactly matches deposit amount
• Trace numbers align (if available)
• Dates are logically consistent

If totals do not match exactly, investigate before posting.

Step 4: Review ERA Contents

Before posting, review what the ERA contains.

Patient verification:

• All patients on ERA are your patients
• Names match your records
• Dates of service are correct

Payment review:

• Payment amounts are reasonable
• Adjustment codes are appropriate
• Denials are identified for follow-up

Step 5: Post to Patient Accounts

Apply the ERA to your PMS.

Auto-posting: Import the 835 file and let your system match to patients and procedures. Review before finalizing.

Manual posting: Work through each patient, applying payments and adjustments to correct dates of service.

Verification: Confirm posted totals match ERA totals.

Understanding MetLife ERA Contents

Header Section

The ERA header includes:

• Payer information (MetLife)
• Payment date
• Total payment amount
• Trace number (EFT) or check number
• Provider information

Claim Detail

For each claim on the ERA:

• Patient name and subscriber ID
• Date of service
• Claim number
• Procedure codes billed
• Amounts: billed, allowed, paid, adjusted

Adjustment Reason Codes

MetLife uses standard HIPAA adjustment reason codes.

Common MetLife codes:

CO-45: Charge exceeds fee schedule/maximum allowable

• Standard contractual adjustment for in-network claims
• Normal and expected

PR-1: Deductible amount

• Patient owes this toward their annual deductible

PR-2: Coinsurance amount

• Patient's percentage of allowed amount

PR-3: Copay amount

• Fixed copay if applicable

CO-50: Non-covered service

• Procedure not covered under patient's plan

CO-29: Time limit for filing has expired

• Claim submitted too late

CO-4: Procedure code inconsistent with modifier

• Coding issue requiring correction

Remark Codes

MetLife includes remark codes for additional context.

Common remarks:

• N362: Missing or invalid prior authorization
• N130: Frequency limitation
• N657: Coverage limitations

Review remark codes to understand payment decisions.

Common MetLife Reconciliation Issues

ERA Total Does Not Match Deposit

The deposit is $11,287.93 but the ERA shows $11,500.00.

Possible causes:

Multiple ERAs in one deposit: Search for additional ERAs that add up to the deposit total.

Take-backs: Previous overpayment being recouped. Look for negative amounts on the ERA.

Timing adjustments: Small differences from payment processing timing.

Investigation:

1. Search for additional ERAs from same date
2. Review ERA for negative line items
3. Contact MetLife if unexplained

Missing ERA for Deposit

Deposit is in the bank but no ERA can be found.

Check these sources:

1. Clearinghouse queue (may not be downloaded yet)
2. MetLife portal directly
3. Paper EOB (may have been mailed)

If still missing:

• Contact MetLife provider services
• Provide deposit trace number
• Request ERA reissuance

ERA With No Corresponding Deposit

ERA shows payment but bank account is empty.

Possible causes:

• Payment in transit (timing)
• EFT information incorrect
• Payment sent to wrong account
• Payment held or stopped

Investigation:

1. Wait 2-3 business days for processing
2. Verify EFT enrollment in MetLife portal
3. Check all practice bank accounts
4. Contact MetLife if payment does not appear

Denied Claims

Claims on the ERA with $0 payment.

For each denial:

1. Review denial reason code
2. Determine if correctable and resubmittable
3. Assess whether appeal is warranted
4. Update patient balance if applicable

Common MetLife denial reasons:

• Missing prior authorization
• Frequency limitation exceeded
• Waiting period not met
• Coordination of benefits required

Take-Backs and Recoupments

MetLife recovers previous overpayments by deducting from current payments.

On the ERA: Appears as negative payment amount with explanation.

How to handle:

1. Locate the original overpaid claim
2. Verify the take-back is valid
3. Adjust original posting
4. Bill patient if they now owe
5. Appeal if take-back is unjustified

MetLife-Specific Considerations

Plan Type Variations

MetLife offers multiple plan types that affect payment.

PPO: Standard claims processing with negotiated fees.

DHMO: Different payment model, often with capitation. Reconciliation differs significantly.

Federal Employees Dental and Vision Program (FEDVIP): Government employee plans with specific rules.

Know which MetLife products you are contracted with and understand each one's payment mechanics.

PDP (Preferred Dentist Program)

MetLife's PPO network is called PDP.

Fee schedule: Contracted fees apply to PDP claims.

Verification: Ensure allowed amounts match your contracted fee schedule.

Network Verification

Verify you are properly credentialed with MetLife.

Issues from credentialing problems:

• Claims paid at out-of-network rates
• Claims denied for network status
• Patient responsibility calculated incorrectly

Periodically verify your network status in the portal.

MetLife EFT Enrollment

Ensure your EFT enrollment is current.

Check:

• Correct bank account on file
• ERA delivery configured
• No pending enrollment issues

EFT information can become outdated after bank changes.

Building a MetLife Reconciliation Routine

Daily

• Check bank for MetLife deposits
• Match each deposit to an ERA
• Post or queue for posting
• Flag unmatched deposits for follow-up

Weekly

• Review aged unmatched MetLife items
• Follow up on denials
• Work resubmission and appeal queue

Monthly

• Reconcile total MetLife deposits to total posted
• Review MetLife AR aging
• Analyze denial patterns
• Verify fee schedule compliance

Quarterly

• Review MetLife network status
• Assess overall MetLife collection rate
• Address systematic issues
• Update procedures if MetLife changes processes

MetLife Contact Information

When you need help with MetLife reconciliation:

Provider Services: 1-877-MET-DDS1 (1-877-638-3371)

Portal Support: Available through the eDental portal help section

ERA/EFT Issues: Contact through provider services or your clearinghouse

Have your Tax ID, NPI, and specific claim or payment information ready when calling.

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