For treatment plans involving onlays, single crowns, implants, prosthodontics,
periodontics, orthodontics and oral surgery services, United Concordia recommends that a
predetermination be obtained before services are rendered under the TRICARE Dental Program (TDP).
By requesting a predetermination, it ensures that both you and your dentist will know
before you receive treatment if the proposed service(s) will be covered and what the
anticipated amount of payment will be from United Concordia.
Follow these simple steps below to request a predetermination from United Concordia:
1
Submit a Claim Form to United Concordia
On the claim form, check the box on top of the form next to “Dentist’s Pre-Treatment
Estimate.” Be sure to include a description of the treatment requested. No dates of service should be reported.
2
United Concordia Notifies You and Your Dentist
United Concordia will notify both you and your dentist via the "Dental
Predetermination Notification and Request for Payment Form" that your predetermination
is finalized. Please note: A predetermination is not a guarantee of payment. Rather, it
indicates how much is payable based on the information in the determination request
and the benefits available at the time the predetermination was processed.
3
Return the Predetermination for Processing
After you receive the treatment for the predetermined service(s), return the "Dental
Predetermination Notification and Request for Payment Form" to United Concordia
indicating the dates the services were provided. If multiple services have been
predetermined, it is not necessary to have all services performed in order for
the predetermination notification to be returned for processing.
TDP predeterminations are valid for six months from the date of finalization. The Dental Predetermination Notification and Request for Payment Form contains the date that the predetermination was approved. If the reported service is performed after the predetermination approval has expired, United Concordia will review the service to determine if it is still eligible for payment.
