Military Dental Treatment Facility TRICARE

Active Duty Dental Program Training

What is the ADDP?• Beginning 1 Aug 09, the ADDP will provide 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.

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 59,000 dentists.

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 – 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

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

(TAMP)• ADSMs of the Commissioned Corps of the Public Health Service (PHS) and

of the National Oceanic and Atmospheric Administration (NOAA)*• 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 and NOAA ADSM dental care is covered by each respective Service.

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.

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.

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.

Claims• United Concordia’s network of over 59,000 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.

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 addpdcf@ucci.com.

• Extenuating circumstances may occasionally prevent ADSMs from cancelling within 24 hours of their appointment. If this occurs, ADSMs must call United Concordia to reschedule. ADSMs should also call United Concordia if they receive a bill for the missed appointment.

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.

• Non-remote ADSMs may appeal a denial by contacting their military DTF.

• It is at the DTF’s discretion whether the appeal will be submitted to United Concordia. If the DTF chooses to file the appeal, it must be sent to United Concordia.

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.

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.

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.

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.

Note: The DART system will be functional at contract start of 1 Aug. 09. Appointments for 1 Aug and later can be made in the month of July by calling a United Concordia Dental Care Finder at 1-866-984-ADDP (2337).

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.

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 Request Form.

This is the Referral Request Form in its entirety. The following slides reference sections of this form.

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

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.

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.

Referral Request Form (continued)• DTF staff must complete the

Appointment Information section for the ADSM receiving care from a civilian provider.

• It is also important to select who will be responsible for making the ADSM’s appointment with the civilian provider.

• Note that United Concordia’s online system will not provide an immediate appointment. To schedule an appointment immediately, the DTF or ADSM should contact United Concordia’s Dental Care Finders at 1-866-984-ADDP (2337) after the Referral Request Form has been completed and submitted.

Referral Request Form (continued)

There are three ways to make an appointment:

1. United Concordia can make the appointment for the ADSM

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

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

Referral Request Form (continued)

• For your convenience, and to alleviate administrative burden, United Concordia encourages you to allow us to make the appointment for the ADSM at a convenient time and with your requested dentist.

– 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.

– You can see the appointment information in the DART system.

Referral Request Form (continued)

• If you or the ADSM would prefer to make the appointment, choose the ADSM in the “Who will be responsible for making the appointment?” field on the form. There are several options from which to choose:

– The ADSM can make an appointment with a United Concordia network dentist. – The DTF staff/designee can make an appointment with a United Concordia

network dentist by calling a Dental Care Finder upon submission of the Referral Request Form.

– DTF staff/designee can make an appointment with a United Concordia network dentist directly.

Note: If the DTF or ADSM chooses to make the appointment, United Concordia will provide a list of three network dentists from which to choose within three calendar days.

If the DTF staff or 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 addpdcf@ucci.com or call 1-866-984-ADDP (2337) with the information.

Referral Request Form (continued)• If the DTF/ADSM has a specific network dentist he/she would like to provide the care,

DTF staff must complete the provider information at the bottom of the page with as much information as possible.

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.

Referral Request Form (continued)

• 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.

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.

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 Referrals button to retrieve the referral to be modified.

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.

Modifying a Referral (continued)

• 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.

Modifying a Referral (continued)

• 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.

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.

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) Saturdayaddpdcf@ucci.com

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

Questions