If you choose not to use the online enrollment tool, use this enrollment form to enroll or to cancel enrollment. Please review the instructions on page 2 for filling out the enrollment form.

Use this form to file a claim for services rendered in the Continental United States (CONUS). For your convenience, this form can be filled out online, printed and mailed to United Concordia.

Use this form to file a claim for services rendered Outside of the Continental United States (OCONUS).

A NARF is an OCONUS form used by Overseas Dental Treatment Facilities (ODTFs) and TRICARE Area Offices (TAOs) to refer enrolled members in remote locations to local host country dentists for orthodontic and implant services. For your convenience, this form can be filled out online, printed and mailed to United Concordia.

The DD Form 2813, DoD Active Duty/Reserve Forces Dental Examination, will be used to assist the TDP-enrolled National Guard/Reserve forces in documenting member dental health.

This form should only be completed when a natural parent who is listed on a TDP contract is authorizing the other natural parent who is not listed on the TDP contract to receive information on their natural child under the age of 18.

This form will need to be completed by the patient/or parent of a child under the age of 18 when a non-participating provider is requesting a reconsideration on their patient’s behalf.

This form will also need to be completed if a member would like to appoint an individual to appeal a claim on their behalf. The member must complete the Request and Authorization for Disclosure of Health Information form and the Appointment of Individual to Act as Appeal Representative Form. Both forms must be received and completed entirely before an appeal can be processed.

If you have other dental insurance in addition to TDP use this questionnaire when submitting a claim.

This form should be completed to release PHI between spouses, for children 18 years and older or any other person not authorized to receive information without written authorization. This is necessary due to HIPAA Privacy Regulations.

If you believe a dentist or entity has received insurance money through the submission of a false claim, you should report this information to the Special Investigations Unit (SIU).

This booklet provides detailed information regarding your TDP benefits and how to manage them. With the PDF format, you can navigate through the sections by clicking on the subject in the table of contents. This booklet is available in English and Spanish. Click on the desired version below.

This brochure provides a concise overview of the TDP. It is provided here in PDF format for easy navigation. This brochure is available in English and Spanish. Click on the desired version below.

TRICARE Dental Health Matters is a publication for TRICARE Dental Program Enrollees.