• ProvidersmustcomplywithseveralcriteriathroughouttheADDPcontracttomaintaintheirSTARproviderdistinctionwithintheADDPDentalNetwork

ChargesADSMswillhavenoout-of-pocketcostsforapprovedcoveredservices.• NetworkdentistswillbereimbursedbyUnited

ConcordiauponcompletionofclaimprocessingandatUnitedConcordia’sMaximumAllowableChargeSchedule.

TreatmentDTF-referred:• AllDTFreferralsrequireanAppointmentControl

Number(ACN)providedbyUnitedConcordiapriortoreceiptofprivatesectorcare.TheACNremainsthesameforalltreatmentlistedandanymodificationsmadeonthereferral.

OnlythoseserviceslistedbytheDTFmaybeprovidedwiththefollowingexceptions:• OralevaluationprocedurecodesD0120,D0140,

orD0150maybeprovidedforADSMsoncepercourseoftreatment,perprovider,ifanexaminationisnotprescribedonthereferral

• 1-2bitewingradiographicimages(D0270orD0272)or1-2periapicalradiographicimages(D0220andD0230)maybeadded

• OralSurgeonsmayperformaD0330panoramicradiographicimage

• Amalgammaybesubstitutedforcompositeresininposteriorrestoration

• OnesurfacemaybeaddedorremovedfromarestorationwithoutDTFreferralmodification;however,analternatematerial(resininsteadofamalgam)cannotbeprovidedwithoutDTFreferralmodification

• D2750maybeperformedasanadequatesubstituteforD2752

• D2750maybeperformedasanadequatesubstituteforD2790onteeth#s3,4,5,6,7,8,9,10,11,12,13,14,19,20,21,22,23,24,25,26,27,28,29,and30

• D2790maybeperformedasanadequatesubstituteforD2792onmolars

• Abuildup(D2950)oraprefabricatedpost&core(D2954)maybeplacedifperformedonthesamedatetheRCTiscompletedbythesameprovider

• D2952(post&core-custom)andD2954(post&core-prefab)maybeperformedasanadequatesubstituteforbuildupsD2950(undersinglecrown)ifthetoothhasbeenendodonticallytreated

• D7210maybeperformedasanadequate

EffectiveAugust1,2014,UnitedConcordiawillbegintheirfive-yearrenewalcontractadministeringTRICAREActiveDutyDentalProgram(ADDP).FollowingaredetailsabouttheADDPyouneedtoknow:

EligibilityTheADDPprovidesprivatesectordentalcareforactivedutyservicemembers(ADSMs)servingin:• U.S.AirForce• U.S.Army• U.S.Navy• U.S.MarineCorps• U.S.CoastGuard• NationalOceanicandAtmosphericAdministration

(NOAA)Corps• NationalGuardandReserveComponentsponsors

calledororderedtoactivedutyformorethan30consecutivedaysand“EarlyActivators”

• PersonnelintheTransitionAssistanceManagementProgram(TAMP)followingactivationforacontingencyoperationformorethan30days

• Foreignmilitarypersonnel(stationedintheU.S.)• LineofDuty(LOD)servicemembers

• WoundedWarriors

ADSMeligibilityisverifiedbyUnitedConcordiauponappointmentrequest.

ADSMsmustbeonactivedutyonthedateprivatesectorcareisreceived.

Program ComponentsTheADDPhastwomajorcomponents:• ADSMswhoarereferredbyamilitarydental

treatmentfacility(DTF);and• ADSMsnotlocatednearaDTF(ie.within50

miles)areconsidered“remote.”Network Requirements• TheADDPrequiresin-networkutilizationviaour

ADDPDentalNetwork;thereisnoout-of-networkbenefit.

• UnitedConcordiaADDPDentalNetworkProvidersarerequiredtoprovideaccessforroutinedentalcarewithin21daysofrequestand28daysofrequestforspecialtycare.

ADDP STAR Providers• Asubsetofpre-selectedproviderswithinthe

ADDPDentalNetwork• Selectedbasedupontheirconsistenttrackrecord

oftreatingasubstantialnumberofADSMswithoutgrievancesorutilizationreviewconcerns,whilecomplyingwiththeADDP’sefficiencyandqualitystandards

Active Duty Dental Program (ADDP)Fast Facts:

substituteforD7140(IVSedationmaybeaddedifthissubstitutionhasoccurred)

• OralsurgeryprocedurecodesD7220,D7230,andD7240mayallbeadequatelysubstitutedforoneanotherwithoutDTFreferralmodificationtoallowfordegreeofdifficultyfluctuations

• OralsurgeryprocedurecodesD7230,D7240,andD7241mayallbeadequatelysubstitutedforoneanotherwithoutDTFreferralmodificationtoallowfordegreeofdifficultyfluctuations

• IVsedationandgeneralanaesthesiaunitsmaybeaddedordeleted

Remote• RemoteADSMscancoordinateroutinecare

throughUnitedConcordia.• TheremoteADSMmustreceiveanACNfrom

UnitedConcordiapriortoreceiptofallprivatesectorcare,exceptemergencies.

• Specialtycare,careinexcessof$750pervisit,ortreatmentplansgreaterthan$1500withinaconsecutive12-monthperiodmustreceiveauthorizationfromUnitedConcordiapriortoreceiptofcare.• Networkdentistscanrequestauthorizationfor

remoteADSMsviaDART+®,whichcanbeaccessedthroughtheADDPwebsite.

ClaimsElectronicclaimsshouldbefiledno sooner than48hoursaftertheappointmentdatetoallowUnitedConcordiatoverifyADSMeligibility.ClaimscannowbesubmittedelectronicallyfromexistingauthorizationsandreferralsinDART+®

• TheACNandDentalReadinessClassificationmustbeincludedoneveryADDPclaim.Claims missing ACNs or Dental ReadinessClassification will deny and require resubmission.Please be sure to enter only numerics in the ACNfield (Letters in the ACN field may cause a claim tosuspend or even reject, especially when submittingclaims electronically.)

Dental Readiness Classification(DRC)DRCsareusedtodetermineiftheADSMisdentallyreadytodeployforworldwideduty.UndertheADDP,thereare3dentalclassificationsthatareused:

Class1:ADSMswithcurrentdentalexaminationswhodonotrequiredentaltreatmentorre-evaluationClass2:ADSMswithcurrentdentalexaminationswhoseoralconditionsareunlikelytoresultindentalemergencieswithin12monthsClass3:ADSMswhorequireurgentoremergentdentaltreatment

ADSMsinClass3doNOTqualifyforworldwidedeploymentandmustreceivenecessarydentaltreatmenttoberatedClass2beforetheyareeligibletodeploy.

Appeals• IftheADSMdoesnotreceiveanauthorization

andACNpriortoreceiptofcare,oriftheprovidersubmitsaclaimforproceduresthatwerenotonthereferral,theclaimmaybedenied

• TherearethreelevelsofappealfortheADDP.TheDTF,ADSMorparticipatingdentist(onbehalfoftheADSM)mayappealaclaimdenialatanyleveloftheprocess

• ADSMsmayappealaclaimbycompletingouronlineappealform

• DentistsmaysubmitanappealonbehalfoftheADSMviaDART+®

• ADSMsordentistsmayalsochoosetosubmitanappealinwriting

Support ServicesPeople:• ADDPDentalProfessionalRelations

Representatives• ADDPCustomerServiceRepresentatives• ADDPDentalCareFinders

Web(www.addp-ucci.com)• ProviderCheckInformation• ProviderDataOnline• ADDPPatientDataTracker• SpeedeClaim®

• ElectronicFundsTransfer(EFT)• DART+®

• ADDPTrainingMaterials• ADDPDentalReferenceGuideValue Added Services• DiscountPricingonSterilizationMonitoring• FreeDavisVisionDiscountProgramforyour

DentalOfficeStaff• DDSLabDiscounts(Receiveexclusivepricingon

dentallabproductsandservices,suchasimplants,aswellascontinuingeducationopportunities)

• EfficientClaim&EncounterSubmissions• ASingleDentalFocus• OnlineAccesstoEligibility,BenefitInformation,

ClaimStatusandCheckDetails• ElectronicFundsTransfer(EFT)foryourclaim

payments(alsoknownasDirectDeposit)

Additional InformationTheADDPwebsite(www.addp-ucci.com)containscomprehensiveprograminformation,anADDPdentistmanual,andaccesstoADDPPatientDataandDART+®.DentalofficesmayusetheirexistingMy Patients’ Benefits loginandpasswordforDART+®andPatientDataTrackeraccess.

Forinformationand/orassistance,dentistscancall(888)286-8454.