United Concordia will accept claims filed on any
standard dental claim form of the American Dental
Association (ADA) or on the
TRICARE Dental Program (TDP) Claim form.
For your convenience, this form can be filled out
online, printed and mailed to United Concordia. A
separate claim form must be submitted for each
enrollee receiving services.
Whether or not you file a TDP claim depends on
the type of dentist - participating or
nonparticipating - you are seeing for
treatment.
TDP Participating Dentists
- If your dentist is a participating
dentist, his or her office will handle all of the
paperwork, including filing claims. United Concordia
will reimburse your dentist directly for covered
services, less the amount you paid for your cost-share.
TDP Nonparticipating Dentists
- If you seek treatment from a nonparticipating
dentist, you may be required to file your own claim.
United Concordia will reimburse you for the claim,
less the amount you paid for your cost-share.
United Concordia will pay a nonparticipating dentist
directly only if you designate on the claim form
that the dentist is to receive the payment.
Additionally, any part of the dentist's fee exceeding
United Concordia's allowance is your responsibility.
Submitting a Claim
When submitting a claim to United Concordia, it is important
that all of the appropriate information is provided.
Failure to provide the necessary information will result
in a claim payment being denied.
If you have to file your own claim(s), be sure
to include the following information on your claim
form:
Date(s) of service
Specific problem encountered
Procedure Code(s)
Specific tooth/teeth treated
for each service performed
Total charges
A complete description of the
service performed, including applicable tooth/
teeth numbers, if a procedure code is not provided
You'll also need to include a dentist's bill or
statement of charges if the specific service(s)
provided are not found on the claim form.
Deadline for Filing Claims Claim forms should be submitted to United Concordia
as soon as possible after the service, preferably within
60 days. Claims submitted more than 12 months after the
month in which the service was provided will be
denied. Prompt submission is especially important
for claims involving an orthodontic treatment plan, because
the banding date is used to determine timely filing.
