Remote Active Duty Dental ProgramBriefing Presented by Rich Panepinto Manager, Benefit Relations United Concordia (850) 995-9024
What is the ADDP? • New program that replaces dental claims processing previously provided by the Military Medical Support Office (MMSO) and other agencies. • Two Distinct Components • DTF Referred • Remote Active Duty Dental Program (RADDP) • Effective 1 August 2009 • Authorized users will be required to use a United Concordia network dentist (Unless pre-authorized by United Concordia) • Must have a Appointment Control Number (ACN) if RADDP or Referral Number if DTF Referred
Current Dental Care ($)Referred to the Private Sector • Costs for Dental Private Sector Care have increased from $17.4 M in FY01 to $151.9 M in FY 08
Geographical Areas of Service • 50 United States • Guam • Puerto Rico • U.S. Virgin Islands • American Samoa • Northern Mariana Islands.
Who is eligible? • Active Duty Personnel of 5 Uniformed Services who live or work more than 50 miles from a military Dental Treatment Facility • Guardsmen and Reservists on orders > 30 days • Foreign military personnel stationed in the U.S. • Early Activators • Line of Duty Personnel Note: Personnel on TAMP are NOT eligible
ADSM Dental Readiness • United Concordia will track Dental Readiness classification for those ADSMs who utilize the ADDP. • Private sector dentist will indicate Dental Readiness on claim form
ADSM Benefits • Benefits will be provided as specified in Attachment 2 of the ADDP contract • Attachment 2 is available on the Web site at www.addp-ucci.com • The ADDP will only pay for covered dental benefits, treatment specifically authorized by the Dental Service Point of Contact (DSPOC), and procedures that have received authorization prior to receipt of care. • If you elect to receive non-covered services, ADSM will be responsible for payment to the dentist. 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.
EMERGENCY Dental Care • Emergency dental care does not require an Appointment Control Number. • Emergency dental care includes any treatment necessary to • relieve pain • treat infection • control bleeding • repair broken fillings by placement of temporary or permanent fillings (not crowns). • Root canal treatment may be needed to relieve the pain and infection, and is considered emergency dental care. • Not required to utilize a United Concordia dentist, but recommended. Follow-up care must be with a United Concordia network dentist.
Claims • Alldental care received under the ADDP must be received from a United Concordia network dentist to be eligible for payment. • Claims willalso be paid for those areas where there are no available network dentists. (as determined by United Concordia)
Cancelled and Missed Appointments • If the ADSM can’t keep the scheduled appointment, they should cancel it preferably no later than 24 hours before the scheduled time. - United Concordia must be notified of the cancellation and reschedule date at 1-866-984-ADDP (2337) or email firstname.lastname@example.org. • Extenuating circumstances may prevent the ADSM from cancelling within 24 hours of the appointment. If this occurs, they can call United Concordia to reschedule. • ADSM should call United Concordia if they receive a bill for the missed appointment
Appeals • Remote ADSMs are required to have an ACN prior to accessing civilian dental care. Without an ACN the claim may be denied. • May appeal a denial by contacting United Concordia. • Remote ADSM may authorize the civilian dentist to file an appeal on your behalf by completing the Authorization to Appeal” Form. Available on the ADDP web site.
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: • The ADSM should address the first incident regarding clinical quality with the treating dentist to provide an opportunity to rectify the concern. If preferred, the ADSM 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 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 for covered procedures or later bill the ADSM for any authorized and/or covered dental care. • United Concordia will receive the dental readiness classification information from providers. ADSMs will not be charged for these services. • Network dentists will provide a copy of treatment rendered upon request of the ADSM. Note: If an ADSM elects to receive a non-covered dental procedure, 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.
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 must 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.
Remote Active Duty Dental Program (ADDP) The Remote ADDP provides private sector dental care to Active Duty Service Members (ADSMs) who live or work 50 or more miles from a military Dental Treatment Facility (DTF).
Remote ADSM: Accessing Routine Care • May personally coordinate your routine covered dental care: (e.g. examinations, cleanings, fillings) as long as the dental treatment is: (1) less than $500 per procedure or appointment or (2) the cumulative total is less than $1,500 for treatment plans that can be completed within a 12-month period AND (3) the procedure must be a covered benefit of the ADDP. • Must FIRST get an Appointment Control Number (ACN) by completing an Appointment Request Form.
Completing and Submitting an Appointment Request Form • Access the Appointment Request Form through the ADDP Web site (www.addp-ucci.com) by clicking on the ADSM / Active Guard & Reserve portal.
Remote ADSM: Making the Appointment The Appointment Request Form provides two options for appointment scheduling: • United Concordia’s Dental Care Finders can make the appointment for ADSMs if they select that option. 2. Remote ADSMs can personally make an appointment with a network dentist by selecting the thatoption in the “Who will be responsible for scheduling the appointment” field on the form.
Making the Dental Appointment2 Options 1. Let United Concordia make the appointment • Dental Care Finders (DCF) will coordinate within two (2) business days • UCCI will ensure the following: • DEERS eligibility • Utilizing a United Concordia Network Dentist • Appointment within 21 days for routine care • Need immediate appointment: Call United Concordia DCF at 1-866-984-ADDP (2337)
Making the Dental Appointment (continued) • ADSM can make their own appointment. * No specific dentist: Within two (2) days of the request DCF will provide a list of three network dentists. ADSM can call a United Concordia network dentist directly and arrange the appointment. * ADSM has a specific network dentist: add dentist contact information to the Appointment Request Form. After ACN is received ADSM can arrange for the appointment * Must notify United Concordia of the appointment date and time.
Remote ADSM: Making the AppointmentReminders • Must wait until you receive the ACN from United Concordia before making an appointment. • Making your own appointment requires you to contact United Concordia with the dentist’s name, date and time of the appointment so their records may be updated. Emailing to: email@example.com or calling 1-866-984-ADDP (2337). • If you have difficulty getting an appointment within 21 days of request contact United Concordia at 1-866-984-ADDP (2337). • You can choose to wait more than 21 days for a specific provider and waive your right to an appointment within 21 days.
Remote ADSM: Accessing Specialty Care Remote ADSMs must receive authorization prior to receipt of dental care for: • Specialty care (e.g. crowns, bridges, dentures, periodontal treatment) • Dental care in excess of $500 per procedure or appointment • Dental care with a cumulative total greater than $1,500 for treatment plans • Receiving dental care from a non-network dentist Note: For implant and orthodontic procedures, Remote ADSM will also need a Command Memorandum from their unit signed by the unit commander or designated representative. This should be submitted by the civilian dentist as an attachment with the completed Authorization Request Form.
Remote ADSM: Accessing Specialty Care • To receive authorization, Remote ADSMs must have their civilian dentist complete an Authorization Request Form. • This form must indicate the procedures desired in order to initiate the authorization request. • This form is available on the ADDP Web site in the Civilian Dentists portal for electronic completion and submission by the dentist. • Upon authorization approval, the ADSM and civilian dentist will be notified and an appointment can be scheduled to initiate care. • The determination of the authorization request can take from to three to five business days.
United Concordia Contact Information ADDP Web site: www.addp-ucci.com Dental Care Finders/Customer Service 1-866-984-ADDP (2337) 8 a.m. to 8 p.m. (ET) Monday through Friday 8 a.m. to 5 p.m. (ET) Saturday firstname.lastname@example.org Inquiries United Concordia Companies, Inc. ADDP Unit P.O. Box 69430 Harrisburg, PA 17106-9430 Claims United Concordia Companies, Inc. ADDP Claims P.O. Box 69429 Harrisburg, PA 17106-9429 Appeals United Concordia Companies, Inc. ADDP Unit – Appeals P.O. Box 69430 Harrisburg, PA 17106-9430 Grievances United Concordia Companies, Inc. ADDP Unit – Grievances P.O. Box 69430 Harrisburg, PA 17106-9430