After you've received dental services, United
Concordia will send you a TRICARE Dental Program (TDP)
Dental Explanation of Benefits (DEOB). The DEOB
is merely a statement that explains what services were
covered and the amount of your
cost-share owed, if any. It is not a bill.
Any cost-share(s) that you owe must be paid to the
dentist, as well as any costs for non-covered services.
Participating dentists will also receive a copy of your DEOB.
Nonparticipating dentists will receive a DEOB if benefits were
assigned and payment is being issued.
Sample DEOB If you are
unfamiliar with a United Concordia DEOB, you may
download a sample to review.
Reading Your DEOB At
the top of the DEOB page, the following information will be
indicated:
Sponsor's name:
The name of the uniformed services member
Last 4 digits of the sponsor's Social
Security number:
Self-explanatory
Page number:
The number of pages in the DEOB
Beneficiary's name:
The name of the enrollee who received the
services
ICN:
The Internal Control Number (ICN) is a
unique number United Concordia uses to identify
the claim. Reference this number if you contact
us with questions about the DEOB.
Date:
The issue date of the DEOB
Provider:
Name of the dentist and the United Concordia
provider number of the dentist who performed
the service
Below this information is a table explaining how your
claim was processed. This table includes the following
information:
Procedure Description / Procedure
Code and Tooth Description
The procedure code identifying the service
performed ("D" + a
four-digit number) and the tooth number
(if applicable) identified by an
asterisk (*)
Service date(s*:
The date the enrollee received treatment
Provider's charge:
The amount charged by the dentist
Allowance:
The amount United Concordia allows for the service
Amount paid:
The amount United Concordia paid for the treatment
after deductions, where applicable
Amount not paid:
Amounts that have not been paid, which includes
the difference between the dentist's charge and
United Concordia's allowance, any cost-share
amounts and other insurance amounts, etc.
Remarks:
The code in this field matches the code in the explanation
field at the bottom of the DEOB. The messages on the bottom
of the DEOB explain:
Whether the dentist who performed
the treatment was a TDP participating dentist or
nonparticipating dentist
The amount paid by United Concordia
Appeal rights and the process for
requesting a reconsideration, if applicable
Note: DEOBs issued for treatment received in the OCONUS
service area may include additional information not indicated on
CONUS DEOBs (e.g., foreign exchange rate). Enrollees should
direct inquiries to the designated
OCONUS Point of Contact (POC) at their installation
or to United Concordia's
OCONUS Customer Service unit.
Questions about a DEOB
Contact United Concordia with questions about a DEOB. Be sure
to have the following information available when calling:
