Diagnostics Material Requirements
When covered, the procedures listed in the ADDP Reference Guide on the Diagnostic Materials Requirement Chart require submission of diagnostic materials for review. (To verify if a remote active duty service member has coverage for a specific procedure, visit the ADDP Patient Data Tracker). Dentists are requested to submit diagnostic materials used for diagnosis and treatment planning.
In addition, dentists must submit diagnostic materials for Service Members living in remote areas when the case must be reviewed by a Military Dental Service Point of Contact (DSPOC) per ADDP contractual guidelines. The diagnostic materials indicated in the DSPOC Authorization Diagnostics chart are considered a minimum requirement for review and pre-authorization by the DSPOCS. Under certain circumstances the DSPOCs may request additional diagnostic material to clarify the requested treatment or prior treatment before rendering a decision for pre-authorization.
All radiographs submitted (including copies) should be pre-treatment unless otherwise noted on the chart. They should be of diagnostic quality and mounted properly with the left and right sides clearly marked. They should be identified with the dentist's name and address, the patient's name and identification number and the date the radiographs were taken. (If a copy of the radiographs is submitted, left or right should be marked on the copy.) Radiographs will only be returned if the dentist provides a self-addressed, stamped envelope with the authorization.
If, for some reason, radiographs are not available, a brief explanation should be included on the ADDP Claim Form. If submitting claims electronically, please provide a brief explanation in the remarks field.