Remote active duty service members (ADSMs) are required to have an Appointment Control Number prior to accessing private sector dental care. If they do not receive one prior to receipt of care, the claim may be denied.
ADSMs referred from a military DTF are required to have a military DTF referral prior to accessing private sector dental care. If they do not receive one prior to receipt of care, the claim may be denied. Their claim may also be denied if they receive care from a civilian dentist that was not included on the DTF referral.
All ADSMs may appeal a claim denial by completing the online appeal form.
Civilian providers may appeal a claim denial on behalf of the ADSM. Providers can submit an appeal through DART®+ by logging in and selecting the "Create New Appeal" button. In order to submit a formal review request, the provider must have the attached Appointment of Individual to Act As Appeal Representative form signed by the beneficiary. The signed appointment appeal form MUST be included in the formal review.
ADSMs and providers may also choose to submit the appeal in writing detailing why they 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 services to be appealed involves a prosthetic procedure 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 written 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 TMA Dental Care Branch. The Surgeon General or designee for the ADSM's Branch of Service decision is final and cannot be appealed.