Frequently Asked Questions
- What is Required to Submit a Claim
Where do I send TDP claims?
United Concordia Companies, Inc.
P.O. Box 69411
Harrisburg, PA 17106
To avoid delays in processing, please use
the appropriate P.O. Box.
My patient's
claim has rejected due to incomplete data.
What do I do now?
Submit a new claim with the required information.
My patient's
claim was rejected for missing information.
The information was reported on the original claim.
What do I do now?
If the information was reported on the original
claim, call Customers Service
(1-800-866-8499)
and verify that all the necessary information was
received. If additional information is still needed,
resubmit the original claim with the required
information to the claims processing department.
When is it necessary
to submit radiographs?
Diagnostic requirements are located on the Reference
Materials page of our web site. From this page,
click on the link for Diagnostic Requirements At
A Glance. NOTE: You will need your My Patients'
Benefits or Speed
eClaimSM
logon and password to access this information.
What diagnostic
materials are required for a tooth with
endodontic treatment that now requires a permanent
restorative procedure?
A periapical radiograph showing the completed root
canal with apices visible is required for all
teeth when requesting a permanent restorative
service (s).
Are radiographs
required for the removal of impacted wisdom
teeth?
Pretreatment radiographs are required if the patient is 31
and over or 14 years and younger. Patient specific
documentation is also required for review.
Are radiographs
required for implants?
Radiographs are required for patients 14
years and younger.
Besides x-rays,
is there any additional information that should be
submitted with the claim?
If the services are crowns, inlays/onlays,
build-ups, bridgework, or prosthetics, it's
very important to include the prescribed date
and the insertion date. If any information is not
available send a narrative/diagnosis of why
the service(s) was provided, and an
explanation as to why x-rays are not available.
What tooth
designators should I report for procedure codes
that indicate a 1 to 3 teeth area?
If a procedure code states a 1 to 3 teeth
area specific tooth numbers should be reported
for proper processing.
I submitted a
claim for orthodontic treatment with a treatment
plan length of 6 months. I received a development
letter. What do I do now?
Orthodontic treatment plans submitted with a
treatment length of 6 months or less and a
total fee of over $2000.00 require
a copy of the patient/doctor contract for
verification of fee and treatment length.
My patient has dual
dental coverage. Is the other insurance explanation
of benefits required?
If the other insurance is primary an explanation
of benefits is required.
I submitted a
claim for my patient and received a letter
requesting my license and tax identification.
Why is this information required?
Contractually, United Concordia is required by the
Federal Government to verify licensure and tax
identification of all providers rendering services
covered under the TRICARE Dental Program.
