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DENTIST'S CLAIM FORM - United Concordia 2026
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- Click ‘Get Form’ to open the DENTIST'S CLAIM FORM in the editor.
- Begin by filling in the patient’s name and relationship to the sponsor. Ensure accuracy as this information is crucial for processing.
- Enter the sponsor's social security number in Box 7, followed by the patient's mailing address in Box 8. This ensures that all correspondence reaches the correct location.
- In Box 14, authorize payment of benefits to the dentist by signing. This allows United Concordia to send payments directly to your dental provider.
- Complete Box 29 with a detailed examination and treatment plan, including tooth numbers and services performed. This section is vital for claims approval.
- Finally, indicate the currency type in Box 33 before submitting your claim form promptly to avoid delays.
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What is dental attachment?
An attachment is a connector consisting of two or more components. One component is connected to a tooth, tooth root, or an implant and the other component is connected to a prosthesis. This component of the attachment is typically incorporated in the crown of a tooth.
What are NEA attachments?
National Electronic Attachment (NEA) allows providers to collect and send documentation such as x-rays, periodontal charts, explanation of benefits (EOBs), narratives or other documents that may be required by a payor in order to process a dental insurance claim.
What attachment needs to be sent with an insurance claim for a crown?
With years of claim submission experience, we know which procedures need claim attachments in order for insurance companies to process them upon initial submission.When dental claims need attachments. Service TypeCommon ProceduresAttachments Needed?MajorCrowns, build ups, bridges, implants, dentures, partialsYes2 more rows Jan 18, 2021
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People also ask
Where do I send my United Concordia dental claim?
TDP CUSTOMER SERVICE CONTACTS Customer Service. P.O. Box 69450. Harrisburg, PA 17106. CONUS Claims Submissions. P.O. Box 69451. United Concordia. Dentist Advisor Unit. Quality of Care/Grievance. Inquiries. Fraud Inquiries. United Concordia. Defense Manpower Data Center Support Office. Defense Manpower Data Center Support Office.
What attachments are needed for dental claims?
What is supporting documentation on a dental insurance claim? X-rays. Intraoral photos. Clinical notes (examples below) Charting. Narratives.
How do I contact United Concordia claims?
If you live in the United States or a U.S. territory:CONUS Toll Free:844-653-4061CONUS Fax:717-635-4565If you live outside of the United states:OCONUS Toll Free:844-653-4060 (view the ATT access codes here)3 more rows
What attachments would you send with a claim that has billed D7286?
D7286 Biopsy of oral tissuesoft (all others) Pathology report, statement of medical necessity; intraoral photograph recommended in addition.
What is the tooth system on a dental claim form?
3. Box 26: Tooth System This system is numbering 1-32 for permanent dentition and lettering A-T for primary dentition. This is also referred to as the American system. JO is used when designating teeth using the Internation Standards Organization (ISO) System.
united concordia tricare phone number
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The Primary Dental Office must complete the Specialty Referral/Claim Form specifying the services referred to the Specialty Care Dentist. The referralRead more