Referral and Authorization Process
United Concordia is required to track all referrals and authorizations for the ADDP. Referrals can be made by the remote active duty service member (self-referral) or a Dental Treatment Facility (DTF).
United Concordia will not reimburse dental care without an authorization or a referral, unless the care is an emergency or it meets the Remote Active Duty Dental Program self-referral conditions described below. Authorization is not required for emergency dental care.
Dental Treatment Facility Referral
When an active duty service member (ADSM) requires civilian dental care that cannot be provided by the Dental Treatment Facility (DTF), the DTF will prescribe a referral. The DTF referral should be accepted as a treatment plan, which is indicated in detail on the referral form. However, if the civilian dentist finds clinical reasoning for alternative treatment, a modified referral is required. Referral modifications are obtained by contacting the DTF prior to treatment being rendered (contact details are provided on the initial referral form).
Remote ADDP Self-Referrals
Remote ADSMs self-refer for most covered benefits, except for care over $750 per appointment or cumulative total of $1500 or more for treatment plans completed within a consecutive 12 month period (and certain designated specialty procedures and/or as noted in the ADDP Dental Reference Guide). Remote active duty service members can only self-refer to network dentists.
Remote ADSMs must receive an instant Appointment Control Number (ACN) before receiving any dental care. They can obtain the ACN by completing an online ACN Request Form or by calling 1-866-984-ADDP (1-866-984-2337)
ADSMs on Extended Leave
Active Duty Service Members (ADSMs) on extended leave (e.g., block, terminal, returning from deployment) more than 50 miles from their DTF, requiring private sector dental care, must contact United Concordia prior to receiving care. As part of the coordination process, United Concordia will confirm the ADSM's status, assign an Appointment Control Number (ACN), and offer assistance in scheduling an appointment with a network dentist.
Dental offices treating DTF-assigned ADSMs on extended leave should follow claim submission and authorization guidelines for the Remote Active Duty Dental program, which can be found in the Dental Reference Guide.
Remote ADDP Authorizations
Authorizations are required for all care that the Remote ADSM cannot self-refer. Care over $750 per appointment or cumulative total of $1500 or more for treatment plans completed within a consecutive 12 month period (and certain designated specialty procedures) must be authorized by the Dental Services Point of Contact (DSPOC), unless the treatment qualifies as emergency dental care. DSPOCs are military dentists assigned as the point of contact for all dental issues arising from care rendered to ADSMs in the civilian community. If the Remote ADSM is located in an area that does not have a network dentist, all care (regardless of cost or treatment) must be authorized by United Concordia.
Authorizations can be submitted electronically via DART®+ by simply logging in to DART®+ and clicking ‘Create New Authorization.’ You will then enter the ADSM’s social security number, date of birth and your United Concordia Provider ID Number and click ‘Continue with New Authorization.’ The ADSM and provider information will pre-populate into the form and you can then enter the necessary services/procedure code information.
Please remember, you must attach all required radiograph and diagnostic materials. Incomplete authorization requests will not be forwarded for DSPOC review.
If your dental practice does not have the ability to submit diagnostic materials electronically as previously stated, authorization requests should be submitted by mailing a completed request form and required diagnostic materials to United Concordia. Radiographs must be of clinical diagnostic quality and clearly indicate the patient’s name and the date the radiograph was taken.
The ADDP Authorization Form, is located under 'Forms'. Print, complete and return the form to:
- United Concordia
- ADDP Authorization Requests
- PO Box 69431
- Harrisburg, PA 17106-9431
For a complete list of diagnostic material requirements, please visit our Diagnostics Materials page.
Proposed treatment and pertinent documentation must be submitted. Please be advised, United Concordia will return original film radiographs if a self-addressed stamped envelope is included with the authorization. Radiographs must be of clinical diagnostic quality and clearly indicate the patient's name and the date the radiograph was taken.
Remember: Authorizations are required for all care that Remote Active Duty Service Members (ADSMs) cannot self-refer. A dentist will be required to obtain an authorization if:
- treatment is greater than $750 per appointment;
- the cumulative total is $1,500 or more for treatment plans completed within a consecutive 12 month period;
- the procedure is considered specialty dental care;
- the procedure is not a covered benefit under the Remote ADDP.