ADDP-REMOTE
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  • Note: network smaller than TDP because no pediatric DDSs included.
  • The ADDP is available to ADSMs of the uniformed services to include the U.S. Air Force, U.S. Army, U.S. Navy, U.S. Marine Corps and the U.S. Coast Guard. National Guard and Reserve Component sponsors called or ordered to active duty for more than 30 consecutive days and “Early Activators” are ADSMs and therefore covered under the ADDP. Foreign military personnel are eligible for private sector dental care under the ADDP. DTF-Referred, only. There are no remote foreign military. These are foreign military personnel stationed in the U.S. Line of Duty (LOD) personnel can be Reserve Component members ( to include National Guard members) or former ADSMs , whose dental condition occurred while they were on active duty. These members are not eligible for DTF or government-paid private sector dental care except in the case of emergencies. If a Reserve Component Member in an active duty status becomes injured or ill during training and requires dental treatment, they are only entitled to treatment for that injury or illness. The responsibility for determining eligibility for treatment rests with local commanders in accordance with published service regulations. The care may be received after a member is inactivated provided that the appropriate LOD documentation is on file; DEERS will not indicate eligibility.
  • Referral procedures will be explained in detail further into the presentation.
  • Frequency limitations: e.g., 2 exams/2 cleanings per 12-month period. Updates to the manual will be posted on the Web site, which goes “live” 1 Jun 09.
  • If an ADSM elects to receive a non-covered dental procedure from a network provider, the ADSM must be informed by the provider, in advance of receiving the procedure, that the procedure is excluded from coverage and the ADSM agrees nevertheless to pay for the procedure. Such agreement to pay by the ADSM will constitute a waiver of the ADSM’s right to be held harmless and will be evidenced in writing, either by written agreement or in clinical notes entered into the ADSM’s dental record with the time, date of agreement and the ADSM’s signature. United Concordia will collect the ADSM’s dental readiness classification information from providers and will report this information on the ADDP Data Elements Report. United Concordia will only report Classification 1,2 or 3; Classification 4 is not used for the ADDP contract. Annually, network providers will complete and give to the ADSM a DD Form 2813, Active Duty/Reserve Forces Dental Examination Form for all Remote ADSMs’ annual dental examination. ADSMs will not be charged for these procedures.
  • Routine Dental Care: Remote ADSMs may personally coordinate their routine covered dental procedures (e.g. examinations, cleanings, fillings)* as long as the dental treatment is less than $500 per procedure or appointment or the cumulative total is less than $1,500 for treatment plans completed within a consecutive 12-month period. *A listing of covered benefits, to include specialty care, is available on the ADDP Web site at www.addp-ucci.com. Click on the Active Duty Service Members portal and select Benefits in the drop down menu on the left. Not all dental procedures are covered under the Remote ADDP. If you elect to receive non-covered procedures, you are responsible for payment. To coordinate their routine dental care, remote ADSMs must get an Appointment Control Number (ACN) by completing an Appointment Request Form. The ACN is provided by United Concordia and must be obtained prior to receipt of all private sector dental care. This includes initial, annual, and continuation of dental care received Aug. 1, 2009 or after. Remote ADSMs can access the Appointment Request Form by logging onto the ADDP Web site at www.addp-ucci.com. Click on the Active Duty Service Members portal and select Appointment Request Form. If they do not have Web access, they should call United Concordia at 1-866-984-ADDP (2337).
  • It is important for ADSMS to remember that they must wait until they receive the ACN from United Concordia before they can make their own appointments. Additionally, making their own appointment requires them to contact United Concordia with the dentist’s name, date and time of the appointment so their records may be updated. They can do so by emailing United Concordia at addpdcf@ucci.com or calling 1-866-984-ADDP (2337). If they have difficulty getting an appointment within 21 days of request contact Untied Concordia at 1-866-984-ADDP (2337).
  • Specialty care (e.g. crowns, bridges, dentures, periodontal treatment)* *For implant and orthodontic specialty procedures, they will also need a Command Memorandum from their unit signed by the unit commander or designated representative. This should be submitted by the civilian dentist as an attachment with the completed Authorization Request Form.
  • In addition to the Authorization Request Form (and Command Memorandum when appropriate), the civilian dentist should include all appropriate diagnostic-quality radiographs as well as any additional information that may be useful to justify the need for the requested treatment. Remote ADSMs should not be billed up front for any covered procedures, except in cases of emergency, and should contact United Concordia before seeking reimbursement. Remote ADSMs are responsible for notifying their command of all dental care received. ADSMs are also responsible for ensuring that the reimbursement request has been submitted by the dentist with the required information and that the payment has been made for the procedures. If Remote ADSMs have questions about the status of a claim, they can check it online at www.addp-ucci.com or by contacting United Concordia at 1-866-984-ADDP (2337). Not all procedures are covered under the Remote ADDP. If ADSMs elect to receive non-covered procedures, they are responsible for payment. For a complete list of covered procedures, visit www.addp-ucci.com.

ADDP-REMOTE ADDP-REMOTE Presentation Transcript

  • Remote Active Duty Service Members TRICARE Active Duty Dental Program Training
  • What is the ADDP?
    • Beginning 1 Aug 09, the ADDP will provide authorized private sector dental benefits under two distinct components for Active Duty Service Members (ADSMs) who are either: Referred from a military dental treatment facility (DTF) (DTF-referred) or reside and work (duty location) greater than 50 miles from a military DTF as part of the Remote Active Duty Dental Program (Remote ADDP)
    • United Concordia pays claims for authorized dental care. Treatment must be provided by a United Concordia network dentist in order to be eligible for payment, unless otherwise designated by United Concordia.
  • Geographical Areas of Service
    • Dental care under the ADDP will be available in the United States, U.S. Virgin Islands, Guam, Puerto Rico, American Samoa, and the Northern Mariana Islands.
    • United Concordia offers an extensive dental provider network of more than 59,000 dentists.
  • Eligibility – Who is eligible?
    • The ADDP is available to ADSMs of the Uniformed Services to include:
      • U.S. Air Force
      • U.S. Army
      • U.S. Navy
      • U.S. Marine Corps
      • U.S. Coast Guard
      • National Guard and Reserve Component sponsors called or ordered to active duty for more than 30 consecutive days and “Early Activators”
      • Foreign military personnel stationed in the U.S.
      • Line of Duty (LOD) service members
  • Eligibility – Who is not eligible?
    • Personnel in the Transitional Assistance Management Program (TAMP)
    • ADSMs of the Commissioned Corps of the Public Health Service (PHS) and of the National Oceanic and Atmospheric Administration (NOAA)*
    • Family members of active duty uniformed services personnel
    • Family members of National Guard and Reserve service members
    • National Guard and Reserve service members who are not on active duty for more than 30 days
    • Retired service members and their families
    • Former spouses
    • Parents and parents-in-law
    • Disabled veterans
    • *PHS and NOAA ADSM dental care is covered
    • by each respective Service.
  • ADSM Dental Readiness
    • United Concordia will track dental readiness classification for all remote ADSMs who utilize the ADDP .
    • Civilian dentists will report the dental readiness of the remote ADSM on each claim submitted.
  • ADSM Benefits
    • Benefits under the ADDP for remote service members will be provided as delineated in the  The Active Duty Dental Benefit (Attachment 2 of the ADDP contract) . The ADDP will only pay for covered dental benefits, non-covered dental benefits specifically authorized by the Government, and those dental benefits that require and have received authorization prior to receipt of dental care. If you elect to receive non-covered services, you will be responsible for payment.
  • Routine Care
    • As a remote ADSM, you may personally coordinate your routine covered dental procedures (e.g. examinations, cleanings, fillings) as long as:
      • Dental treatment is less than $500 per procedure or appointment or
      • The cumulative total is less than $1,500 for treatment plans completed within a consecutive 12-month period
      • AND
      • The procedure must be a covered benefit as listed in The Active Duty Dental Benefit.
      • An Appointment Control Number (ACN) provided by United Concordia must be obtained prior to receipt of care for all courses of treatment, regardless of cost.
  • Specialty Care
    • As a remote ADSM, you must receive authorization prior to receiving:
      • Specialty dental care (e.g., crowns, bridges, dentures, periodontal treatment)*
      • Dental care in excess of $500 per procedure or appointment
      • Dental care with a cumulative total greater than $1,500 for treatment plans completed within a consecutive 12-month period
      • Dental care from a non-network dentist
    • * For implant and orthodontic specialty services, you will also need a Command Memorandum from your unit signed by the unit commander or designated representative. This should be submitted by the civilian dentist as an attachment with the completed Authorization Request Form .
  • Emergency Care
    • Emergency dental care procedures under the ADDP for remote service members consist of the following:
      • Emergency dental care does not require an authorization or Appointment Control Number (ACN).
      • Emergency dental care includes any treatment necessary to relieve pain, treat infection, or control bleeding. Root canal treatment may be needed to relieve pain and infection, and is considered emergency dental care.
      • Crowns, bridges, and denture services are not considered emergency dental care and, therefore, are not covered. As such, ADSMs who elect to receive non-covered services as part of an episode of emergency dental care are responsible for payment of these services.
      • It is recommended that you use a United Concordia network dentist for emergency dental care. Although this is not required, any follow-up care with a non-network dentist will not be authorized and you will be responsible for payment.
  • Claims
    • United Concordia’s network of over 59,000 dentists will submit ADDP claims to United Concordia for payment.
    • All dental care received under the ADDP must be received from a United Concordia network dentist to be eligible for payment. Claims will be paid for those areas where there are no available network dentists as determined by United Concordia.
  • Cancelled and Missed Appointments
    • If you are unable to keep an appointment, you should attempt to cancel it with the civilian dentist at least 24 hours before your scheduled visit. To cancel or reschedule an appointment, notify United Concordia at addpdcf@ucci.com or 1-866-984-ADDP (2337).
    • Extenuating circumstances may occasionally prevent you from canceling within 24 hours of your appointment. If this occurs, call United Concordia to reschedule. You should also call United Concordia if you receive a bill for the missed appointment. If you choose to personally reschedule the appointment, you must inform United Concordia of the new date and time.
  • Appeals
    • You are required to have an Appointment Control Number prior to accessing private sector dental care. If you do not receive one prior to receipt of care, your claim may be denied. You may appeal a claim denial by contacting United Concordia.
    • You may authorize the civilian provider to file an appeal on your behalf by completing the Authorization to Appeal Form available on the ADDP Web site.
  • Grievances
    • United Concordia is committed to providing quality outcomes through our network of dental professionals. We employ benchmark utilization reviews to ensure network dentists provide industry-standard levels of treatment.
    • United Concordia has well established Grievance and Appeal programs to ensure patient satisfaction and address quality concerns. If you have a quality concern regarding procedures that have been received from a United Concordia network dentist, please address them in the following manner:
      • You should address the first incident regarding clinical quality with the treating dentist to provide an opportunity to rectify the concern. If preferred, you can request that United Concordia contact the treating dentist for corrective action.
      • If the treating dentist does not correct the issue after the initial request, you should contact United Concordia to address your concerns.
    • To file a grievance, download the Grievance Form from the ADDP Web site and submit it to United Concordia by mail or fax.
  • Civilian Providers
    • Network Providers
      • Network providers will not collect payment from ADSMs for covered procedures or later bill you for any authorized and/or covered dental care.
      • If you elect to receive a non-covered dental
      • procedure from a network provider, you must be
      • informed by the provider, in advance of receiving the treatment,
      • that the procedure is excluded from coverage and agree
      • to pay for the treatment.
      • United Concordia will receive your dental readiness
      • classification information from providers. You will not be
      • charged for these services.
      • Network dentists will provide a copy of rendered treatment
      • upon request.
  • Civilian Providers (continued)
    • Non-network Providers
      • If you are approved for care from a non-network provider who demands payment up front, you should contact United Concordia who will arrange reimbursement to the provider.
      • If you have paid a non-network provider in an emergency situation, United Concordia will reimburse you directly.
  • Make an Appointment
    • Routine Dental Care :
    • As a remote ADSM, you may personally coordinate your routine covered dental procedures (e.g. examinations, cleanings, fillings) as long as the dental treatment is less than $500 per procedure or appointment or the cumulative total is less than $1,500 for treatment plans completed within a consecutive 12-month period.
    • To coordinate routine dental care, you must get an Appointment Control Number (ACN) by completing an Appointment Request Form.
  • Remote ADSM Steps to Make an Appointment
    • You can access the Appointment Request Form through the ADDP Web site (www.addp-ucci.com) by clicking on the Active Duty Service Members portal.
    • United Concordia’s Dental Care Finders can make the appointment if you select the United Concordia option in the “Who will be responsible for scheduling the appointment” field on the form.
    • You can personally make an appointment with a United Concordia network dentist by selecting the ADSM option in the “Who will be responsible for scheduling the appointment” field on the form.
    Remote ADSM Steps to Make an Appointment The Appointment Request Form provides two options for appointment scheduling:
    • If you allow United Concordia to make the appointment for you, you can enter the name and contact information of the network dentist you would like to utilize or leave that area blank. United Concordia will then coordinate the appointment with you and a network dentist within two business days of the request. If you would like to make an appointment immediately, call United Concordia at 1-866-984-ADDP (2337) upon form submission.
    • 2) If you choose to make your own appointment, you can request a network dentist that is familiar to you by adding the dentist’s contact information in the “Do you have a provider preference?” field on the form. United Concordia will then provide you with a list of three dentists, to include any that you requested, within three business days of Appointment Request Form submission. You can also call United Concordia at 1-866-984-ADDP (2337) for the list of three network dentists in your area. The list of dentists provided by United Concordia will also include your Appointment Control Number (ACN).
  •  
  • Making an Appointment with a Civilian Dentist
    • It is important to remember that you must wait until you receive the ACN from United Concordia before you can make your own appointments.
    • Additionally, making your own appointment requires you to contact United Concordia with the dentist’s name, date and time of the appointment so their records may be updated. You can do so by emailing United Concordia at addpdcf@ucci.com or calling 1-866-984-ADDP (2337).
    • If you have difficulty getting an appointment within 21 days of request contact United Concordia at 1-866-984-ADDP (2337).
    • You can choose to wait more than 21 days for a specific provider and waive your right to an appointment within 21 days.
  • Remote ADSM Steps to Make an Appointment
    • Specialty and Other Private Sector Dental Care:
    • You must receive authorization prior to receipt of dental care for:
    • Specialty care (e.g. crowns, bridges, dentures, periodontal treatment)
    • Dental care in excess of $500 per procedure or appointment
    • Dental care with a cumulative total greater than $1,500 for treatment plans
    • Seeing a non-network dentist
  • Remote ADSM Steps to Make an Appointment
    • To receive authorization, have your civilian dentist complete an Authorization Request Form.
      • This form must indicate the procedures desired in order to initiate the authorization request.
      • This form is available on the ADDP Web site in the Civilian Dentists portal for electronic completion and submission by the dentist.
      • Upon authorization approval, you and the civilian dentist will be notified and an appointment can be scheduled to initiate care.
      • The determination of the authorization request can take from to three to five business days.
  • United Concordia Contact Information
    • ADDP Web site: www.addp-ucci.com
    • Dental Care Finders/Customer Service
    • 1-866-984-ADDP (2337)
    • 8 a.m. to 8 p.m. (ET) Monday through Friday
    • 8 a.m. to 5 p.m. (ET) Saturday
    • [email_address]
    • Inquiries
    • United Concordia Companies, Inc.
    • ADDP Unit
    • P.O. Box 69430
    • Harrisburg, PA 17106-9430
    Claims United Concordia Companies, Inc. ADDP Claims P.O. Box 69429 Harrisburg, PA 17106-9429 Appeals United Concordia Companies, Inc. ADDP Unit – Appeals P.O. Box 69430 Harrisburg, PA 17106-9430 Grievances United Concordia Companies, Inc. ADDP Unit – Grievances P.O. Box 69430 Harrisburg, PA 17106-9430
  • Questions