** Notice for ADDP Members Impacted by Natural Disasters **

United Concordia is dedicated to helping ADDP members impacted by natural disasters. We realize you are wrestling with many issues and concerns in light of this tragedy - your dental care shouldn't be one of them.

If you have been displaced as a result of a natural disaster and your ADDP benefits and/or access to care have been affected, please contact us at 1-866-984-2337. We are committed to helping our enrollees affected by tragedy. Please do not hesitate to contact us so we can be of assistance.

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Appeals and Grievances

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 completing the online appeal form. The form must be completed in its entirety with information found on the ADSM’s dental explanation of benefits (DEOB). If you do not have the DEOB, you can contact United Concordia at 1-866-984-ADDP (1-866-984-2337) to check the claim status and receive this information.

You may also choose to submit an appeal in writing detailing why you are appealing denied charges, as well as a copy of the bill. Paper appeals should be sent to United Concordia at:

  • United Concordia Companies, Inc.
  • ADDP Unit - Appeals
  • P.O. Box 69430
  • Harrisburg, PA 17106-9430

There are three levels of appeal for the ADDP.

First Level. Any appeal of a claim denial must be submitted to United Concordia within 90 calendar days of the notice of the denial. United Concordia will forward the appeal to the dental service point of contact (DSPOC) who will issue a decision to United Concordia. United Concordia will then notify the ADSM (or the person initiating the appeal) of the DSPOC's decision. Please note: The appeal request must be submitted with the appropriate diagnostic materials. If the dental service to be appealed involves a prosthetic procedure (e.g., crown, bridges, etc.) that requires cementation, the appeal must also include a radiograph showing the completed prosthetic procedure. For a complete listing of diagnostic materials required, please view the Diagnostic Material Requirements.

Second Level. In the event the DSPOC denies the appeal, then the ADSM (or authorized representative) may request an additional review of the DSPOC's decision within 30 calendar days of receipt of the denial. In order to obtain further review of the DSPOC's decision, the ADSM (or authorized representative) must submit a request for review of the DSPOC's decision to United Concordia. The request for review must include a copy of the DSPOC's original decision. The DSPOC will review the appeal and issue a decision to United Concordia, either affirming or reversing the DSPOC's first level decision. The decision may overrule the previous decision in whole or in part.

Final Level. In the event that the DSPOC affirms the first-level decision, the ADSM (or authorized representative) may seek further review by submitting a request to United Concordia within 30 calendar days of receipt of the second decision. The request must include copies of the first and second level decisions. United Concordia will forward the request to the DSPOC for review by the Surgeon General or designee for the ADSM's Branch of Service, with a copy to the DHA Dental Care Branch. The Surgeon General or designee for the ADSM's Branch of Service decision is final and cannot be appealed.

 

Grievances/Quality of Care Concerns

United Concordia is committed to providing quality outcomes through our network of dental professionals. We have a Dental Oversight Committee comprised of experienced dentists that credentials network providers every three years and monitors quality issues. Actions to correct quality issues include educational letters to providers, review of their patient records, in office review of records and examination of patients by a dental director, and termination from the network. We employ benchmark utilization reviews to ensure network dentists provide industry-standard levels of treatment. Our team of dentist advisors perform pre and post payment clinical reviews. 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, submit the online  Grievance Form to United Concordia. You may also print and mail or fax this form to United Concordia. The printed form can be faxed to 717-635-4560 or mailed to:

  • United Concordia
  • ADDP - Grievances
  • 4401 Deer Path Road, DP-1E
  • Harrisburg, PA 17110-3907

For more information about the grievance process, consult the Quality of Care Concern Flow Chart.

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