military dental treatment facility tricare active duty dental program training

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Military Dental Treatment Facility TRICARE

Active Duty Dental Program Training

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What is the ADDP?• The ADDP provides 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)

• The ADDP is designed to augment, not replace, dental care provided in military DTFs.

• 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.

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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 70,000 dentists.

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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 – NOAA Corps– 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*– Wounded Warriors

*LOD documentation must be submitted to United Concordia prior to receipt of private sector dental care. Submission is NOT considered authorization. The Government will review the LOD paperwork and United Concordia will notify ADSMs of the determination.

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Eligibility – Who is not eligible?• Personnel in the Transitional Assistance Management Program (TAMP) –

Note that personnel on TAMP following activation for a contingency operation for more than 30 days will be eligible upon Congressional legislative approval (expected by 2012 year end). Personnel on TAMP not related to a contingency operation will remain ineligible for the ADDP.

• ADSMs of the Commissioned Corps of the Public Health Service (PHS)*• 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 ADSM dental care is covered by the Service.

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ADSM Dental Readiness• United Concordia will track dental readiness

classification for all ADSMs who utilize the ADDP.

• To ensure accurate readiness tracking, military DTFs must indicate the current dental readiness of the ADSM and the expected dental readiness after treatment on each referral. The dental readiness status of ADSMs can be tracked in United Concordia’s online system.

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ADSM Benefits• Benefits will be provided as delineated in The Active Duty Dental

Benefit (Attachment 2 of the ADDP contract).

Frequency limitations noted in The Active Duty Dental Benefit do not apply to DTF-referred ADSMs.

The Active Duty Dental Benefit is available in your DTF manual and on the ADDP Web site (www.addp-ucci.com).

Note: Uniformed Service-specific processes (e.g., evaluation boards for orthodontics and implants) are not affected by the ADDP. Current procedures utilized by the Services still apply if desired. Further, orthodontics requires Government approval. Details are available on the ADDP Web site.

http://www.addp-ucci.com/

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Emergency Care• Emergency dental care procedures established by the military DTF apply to

all non-remote ADSMs. They should contact their local military DTF for a list of policies pertaining to emergency dental care.

• Non-remote ADSMs who are traveling (leave, duty-related) do not require an appointment control number (ACN) or referral if they are not within 50 miles of a military DTF. They may seek treatment from any civilian dentist, however follow-up care with a non-network dentist is not authorized.

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Claims• United Concordia’s network of over 70,000 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.

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Cancelled and Missed Appointments• If ADSMs are unable to keep an appointment with the civilian dentist, they

should cancel it as soon as possible, preferably no later than 24 hours before the scheduled appointment. ADSMs must notify United Concordia upon appointment cancellation or reschedule at 1-866-984-ADDP (2337) or email [email protected].

• Extenuating circumstances may occasionally prevent ADSMs from cancelling within 24 hours of the appointment. If this occurs, ADSMs can call United Concordia to reschedule. ADSMs can also submit an appeal to United Concordia if they receive a bill for a missed appointment. The Appeal should include a detailed explanation as to why the appointment was missed and must be submitted in writing to United Concordia at:

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

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Appeals• The ADSM is required to have a DTF referral with an Appointment

Control Number (ACN) prior to accessing civilian dental care.

• If the ADSM does not receive an ACN prior to receipt of care, the claim may be denied.

• There are three levels of appeal for the ADDP. The DTF or the ADSM may appeal a claim denial at any level of the process by contacting United Concordia in writing at:

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

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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 there is a quality concern regarding procedures that have been performed by a United Concordia network dentist, please address them in the following manner:

– Either the ADSM or the DTF should address the first incident regarding clinical quality with the treating dentist to provide an opportunity to rectify the concern. If preferred, the DTF 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, the ADSM or DTF should contact United Concordia to address the concerns.

• To file a grievance, download the Grievance Form from the ADDP Web site (www.addp-ucci.com) and submit a signed copy to United Concordia by mail or fax.

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Civilian Providers• Network Providers

– Network providers will not collect payment from ADSMs for covered procedures or later bill the ADSMs for any authorized and/or covered dental care.

– 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 treatment, that the procedure is excluded from coverage and the ADSM agrees to pay for the treatment.

– United Concordia will receive the ADSM’s dental readiness classification information from providers. ADSMs will not be charged for these services.

– Network dentists will provide a copy of rendered treatment upon request of the military DTF or ADSM.

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Civilian Providers (continued)

• Non-network Providers– If the ADSM is approved for care from a non-network

provider who demands payment up front, the ADSM will contact United Concordia who will arrange reimbursement to the provider.

– When an ADSM has paid a non-network provider in an emergency situation and seeks reimbursement, United Concordia will reimburse the ADSM.

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Steps to Referring ADSMs for Private Sector Dental Care

• ADSMs who live and/or work within 50 miles of a military DTF must receive a referral from their DTF before making an appointment with a civilian dentist or receiving any private sector dental care.

• After you have determined private sector dental care is required to maintain or achieve dental readiness, you’ll need to follow these steps to ensure timely access to a civilian dentist.

• The ADDP’s newest online feature, the Dental Authorization & Referral Tracker (DART), allows you to submit referrals for ADSMs online. In addition, you can modify referrals and monitor the appointment status of each ADSM.

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Completing and Submitting a Referral Request Form

• Access the Referral Request Form through the ADDP Web site (www.addp-ucci.com) by clicking on the Government portal.

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Referral Request Form (continued)• Click the DART link on the left navigation bar.

• Log in to United Concordia’s Dental Authorization & Referral Tracker (DART) system using the login ID and password provided by United Concordia.

• Click the Create New Referral button to open a new Referral Form

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Referral Launch Page• You can verify ADSM eligibility and referral/Appointment Control Number (ACN)

history and provider information from the Referral Launch Page. If no eligibility is returned for the ADSM, you can still complete the referral, but inform the ADSM that he/she must be eligible for ADDP care at the time of the private sector dental appointment in order for the claim to be paid by United Concordia. If no eligibility is found, the ADSM should contact his/her personnel office to update eligibility.

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• To obtain ADSM referral and ACN information, simply type the ADSM’s social security number in the space provided and push the “tab” button. A list of the five most recent referrals and ACNs are displayed (below). To modify a referral, select the referral number from the displayed results.

Referral Launch Page (continued)

Enter the SSN here

Referral/ACN information is displayed here

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• To obtain ADSM eligibility, enter the date of birth in the space provided (after entering the social security number) and tab off the field. The ADSM’s eligibility is displayed in the section directly above the referral history.

Enter the date of birth here

ADSM eligibility will appear here

Referral Launch Page (cont.)

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• If you know the name of the United Concordia network provider you’d like to use, enter the United Concordia provider ID in the field provided and push “tab.” The network provider’s information will be displayed in the section next to the member’s eligibility.

Enter the United Concordia provider ID here The network provider

information will display here

Referral Launch Page (cont.)

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To continue with the new referral process, click “Continue with New Referral.”

The Referral Request Form appears and the member and United Concordia network provider data will be pre-populated. This is the Referral Request Form in its entirety. The following slides reference sections of this form.

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Referral Request Form (continued)

• The Referral Request Form will automatically populate with a Referral Number and Appointment Control Number. These numbers will be attached to the ADSM’s referral and appointment request for the life of the treatment plan referenced in the referral.

• The form will also auto-populate with the name and email address of the DTF staff member who is logged into DART.

• The ADSM will not receive private sector dental care without first receiving a completed Referral Request Form from the military DTF.

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Referral Request Form (continued)• United Concordia will track the dental readiness of all ADSMs receiving

civilian dental care upon completion of treatment indicated on the referral.

• You must select the ADSM’s current dental readiness classification and the expected readiness classification. Note that Class 4 is not a utilized class with the ADDP.

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Referral Request Form (continued)• It is the DTF staff’s responsibility to complete the Referral Request Form in

its entirety. All required fields are marked with an asterisk and must be completed before the form will be accepted.

• The Service section must be completed with all dental procedures you wish to be performed by the civilian dentist. The procedure code drop-down box is pre-populated with a list of CDT codes of covered procedures. You should also include either the tooth number or tooth range as well as the tooth surface(s) that should receive the referred procedures.

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• The Member Information section will be auto-populated with the ADSM’s contact information retrieved from DEERS during the initial eligibility check. If this information is incorrect, you should update it on the referral; however, it will not update the ADSM’s records in DEERS.

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Referral Request Form (continued)• It is important to select who will be responsible for making the ADSM’s appointment with the civilian provider. If

the DTF wishes to make the appointment, the network provider information must be filled in. This information will auto-populate when the UCCI provider number is entered (either on the form or on the launch page).

• If the DTF/ADSM has a specific network dentist he/she would like to provide the care (no matter who is responsible for making the appointment), DTF staff must select a United Concordia network provider.

Note: ADSMs must use a United Concordia network dentist. Exceptions to this rule may only be granted when there is not a network dentist available in their area.

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There are three ways to make an appointment:

1. The DTF can make the appointment with a United Concordia network dentist for the ADSM

2. The ADSM can personally make the appointment with a United Concordia network dentist

3. United Concordia can make the appointment for the ADSM

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• For your convenience, either you or the ADSM can make the appointment, provided you schedule it with a United Concordia network dentist using the Find a Dentist application on the ADDP Web site. Choose “DTF” in the “Who will be responsible for making the appointment?” field on the form to have the DTF make the appointment or “ADSM” to have the ADSM make the appointment.

• If the ADSM chooses to make the appointment, United Concordia will provide the ADSM with an ACN. ADSMs will be reminded of the necessity to use a United Concordia network dentist when scheduling the appointment.

• If the ADSM makes the appointment with the provider, he/she must then contact United Concordia with the provider’s name and the appointment date and time. Either email [email protected] or call 1-866-984-ADDP (2337) with the information.

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Include Appointment Information• If the DTF makes the appointment for the ADSM, you must include the

United Concordia Provider ID and the ADSM’s appointment information on the Referral Request in the date/time area.– To locate a network provider or provider ID, click the Find a Dentist link

on the Referral Request Form.

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Find the Provider Number• After searching Find a Dentist and selecting the provider you’d like

to use, click the provider’s name to view the details page.

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Find the Provider ID• Copy and paste the Provider Number (not the NPI) into the Referral

Request and click the Retrieve Provider Data button. The rest of the provider’s information will auto-populate on the form.

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Include Appointment Date/Time• If the DTF makes the appointment for the ADSM, you must include the

ADSM’s appointment information on the Referral Request in the date/time area.– To schedule the appointment with a network provider, click the Find a

Dentist Link on the right

–Note that the default for scheduling the appointment is “DTF.” If you select DTF, you must input the Provider Number and

appointment date/time before submitting the Referral Request.

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• If you would prefer to have United Concordia make the appointment, select “United Concordia” in the “Who will be responsible for making the appointment?” field on the form.

– United Concordia will make the appointment within two (2) business days of request.

– United Concordia will ensure the ADSM is seen within 21 days of request for routine care and within 28 days for specialty care.

– If possible, use the ADSM’s email address rather than phone number for preferred contact method. This expedites requests.

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• Print the Referral Request Confirmation page for the ADSM to take to his/her appointment with the civilian dentist. This page will display the procedures needed and the ACN.

• ADSMs must be on active duty at the time dental care is provided under the ADDP. Claims received for ADSMs not on active duty will be denied and the ADSM will be responsible for all charges related to that care.

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Common Referral ErrorsThe following list contains some of the most common mistakes DTF staff make when completing referrals:

•Placing multiple procedure codes on a single referral that will require treatment at different offices (e.g., crown, cleaning, implant). A separate referral must be completed for each service requiring treatment at a unique provider office.•Not including tooth numbers or surfaces with procedure codes.•Multiple exam codes for different tooth numbers on one referral (D0120 tooth #3, D0120 tooth #4, D0120 tooth #9). Only one exam code can be applied per referral.•Only creating a referral for an exam and writing in the notes field that X-rays or additional codes may be added. If it’s not included in the exceptions (see slide 38), then ALL codes desired by the DTF must be included on the referral.•Submitting referrals as “ADSM responsible” and subsequently instructing the member to contact ADDP to schedule an appointment.•Scheduling an appointment with a non-participating provider.

– Not verifying that the provider is a United Concordia participating dentist (PAR status) by using Find a Dentist link located on the referral.

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Modifying a Referral• ADSMs will only receive the procedures prescribed on the referral.

• No alternate procedures will be provided unless approved by the DTF with another referral.*

• Civilian providers may contact the DTF directly to discuss additional procedures which the ADSM may need.

– When this occurs, the DTF staff will need to modify the existing referral to include new procedures and/or remove procedures that the ADSM will no longer receive.

• The Referral Modification screen will also show an ADSM’s scheduled appointment date and time.

*Exceptions to this rule are listed on the following slide.

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Alternate ProceduresThe following exceptions to not require a DTF referral modification:

• Oral evaluation procedure codes D0120, D0140 and D0150 may be provided for ADSMs once per course of treatment, per provider, if no other examination is prescribed.

• 1-2 bitewing films (D0272) or 1-2 periapical films (D0220 and D0230) may be added.• Amalgam may be substituted for composite resin in posterior restoration. However,

no other alternate materials can be provided without DTF referral modification.• One surface may be added or removed from a restoration without DTF approval.• IV sedation and general anesthesia units may be added or deleted.• Oral Surgeons may perform a D0330 panoramic film.• Oral surgery procedure codes D7220, D7230 and D7240 can be substituted for one

another. Additionally, D7230, D7240 and D7241 can also be substituted for one another.

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Modifying a Referral in the DART System• To modify a referral,

log onto the DART system using the login ID and password provided by United Concordia.

On the home page, click the Search Referral button to retrieve the referral to be modified.

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Modifying a Referral (continued)

• Enter the Referral Number, Member Social Security Number, Appointment Control Number or Dental Treatment Facility to search for referrals with the selected search criteria.

• The United Concordia Provider ID may be used to narrow the search but cannot be used as the only search criteria.

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• The DART system will return all referrals based on the search criteria. Results will be displayed at the bottom of the page.

• Select the referral to

be modified.

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• The Referral Modification form allows DTF staff to add or delete procedures on the original referral.

• To add another procedure, select the Add Another Service button under the Service box.

• To delete a procedure that is no longer necessary, change the Line Status of that procedure to Deleted in the drop-down menu.

• To modify/change a procedure, delete the old procedure and add a new one.

• After all items have been updated, click the Submit button at the bottom of the page.

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Data Warehouse

• Provider utilization• Referrals• Authorizations (for remote ADSMS)• Claims processing• Claims payment• ADSM care and procedure data• Incurred cost data• Dental readiness classifications

An online data warehouse houses all data files associated with the ADDP contract including data concerning:

The data warehouse is updated overnight every night with United Concordia’s current data. Claims data is updated on a weekly basis.

The Government has access to all data associated with the ADDP 24 hours a day, 7 days a week.

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United Concordia Contact Information

ADDP Web site: www.addp-ucci.com

Dental Care Finders/Customer ServicePhone: 1-866-984-ADDP (2337)Fax: 1-866-308-41388 a.m. to 8 p.m. (ET) Monday through Friday8 a.m. to 5 p.m. (ET) [email protected]

InquiriesUnited Concordia Companies, Inc.ADDP UnitP.O. Box 69430Harrisburg, PA 17106-9430

ClaimsUnited Concordia Companies, Inc.ADDP Claims P.O. Box 69429Harrisburg, PA 17106-9429

AppealsUnited Concordia Companies, Inc.ADDP Unit – AppealsP.O. Box 69430Harrisburg, PA 17106-9430

GrievancesUnited Concordia Companies, Inc.ADDP Unit – GrievancesP.O. Box 69430Harrisburg, PA 17106-9430

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military dental treatment facility tricare active duty dental program training

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