You should request a predetermination of payment from
United Concordia for all orthodontic, dental implant and complex
treatment plans.* When you submit the predetermination request
after your initial exam with the referred orthodontist, complete a
TDP OCONUS Claim Form and include a statement from the host
nation orthodontist identifying the total cost of all treatment
needed. United Concordia will review and provide the patient with
a summary of the covered costs.
Follow the simple steps below to request a predetermination
from United Concordia:
1
Submit a Claim Form to United Concordia
On the TDP OCONUS 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 host nation 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 at the time the predetermination request is made.
3
Return the Predetermination for Processing
After you receive the treatment, 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.
After receiving the predetermination, the sponsor may submit
the second, or final
Non-Availability Referral Form (NARF) approving the implant services,
the TDP OCONUS Claim Form, and the dentist's bill for full implant
services to United Concordia for payment.
*If you are receiving implant services from a TRICARE OCONUS Preferred Dentist
(TOPD), the TOPD has agreed to submit your predeterminations to
United Concordia.
