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.
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