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TRICAREĀ® Dental Program
Dentists Government
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Dentists Government

United Concordia is dedicated to helping our TDP enrollees throughout the country who have been impacted by a disasters. We realize you are wrestling with many issues and concerns in light of the current situation - your dental care shouldn’t be one of them. 

If your dental treatment has been impacted by a recent disaster, please contact United Concordia’s disaster line at 1-800-858-0051 to locate a dentist, coordinate benefits, and answer any questions regarding dental coverage. Please let us know you’ve been affected by the disasters when you call.

EDUCATIONAL MATERIALS

TDP Benefit Booklet
This booklet provides detailed information regarding your TDP benefits and how to manage them.
Download
TDP Benefit Brochure
This brochure provides an overview of the TDP.
Download

FORMS

Enrollment Form
If you choose not to use the online enrollment tool, use this enrollment form to enroll or to cancel enrollment. Please review the instructions on page 2 for filling out the enrollment form.
Download
TDP Claims Form (CONUS)
Use this form to file a claim for services rendered in the Continental United States (CONUS). For your convenience, this form can be filled out online, printed and mailed to United Concordia.
Download
TDP Claims Form (OCONUS)
Use this form to file a claim for services rendered Outside of the Continental United States (OCONUS).
Download
NARF (Non Availability Referral - OCONUS Only)
A NARF is an OCONUS form used by Overseas Dental Treatment Facilities (ODTFs) and TRICARE Area Offices (TAOs) to refer enrolled members locations to local host country dentists for orthodontic services. For your convenience, this form can be filled out online, printed and mailed to United Concordia.
Download
Custodial Parent Release Form
This form should only be completed when a natural parent who is listed on a TDP contract is authorizing the other natural parent who is not listed on the TDP contract to receive information on their natural child under the age of 18.
Online Form Download
POA (Power of Attorney)
Use this form to submit Power of Attorney information in order to manage the TDP account on behalf of the sponsor.
Online Form Download
HIPAA Privacy Release Form
This form should be completed to release PHI between spouses, for children 18 years and older or any other person not authorized to receive information without written authorization. This is necessary due to HIPAA Privacy Regulations.
Online Form Download
Appointment of Individual to Act As Appeal Representative Form
This form will need to be completed by the patient/or parent of a child under the age of 18 when a non-network provider is requesting a reconsideration on their patient's behalf.

This form will also need to be completed if a member would like to appoint an individual to appeal a claim on their behalf. The member must complete the Request and Authorization for Disclosure of Health Information form and the Appointment of Individual to Act as Appeal Representative Form. Both forms must be received and completed entirely before an appeal can be processed.
Online Form Download
Appeals
You may appeal a claim denial by completing the Appeal Form. The form must be completed entirely and submitted to United Concordia before an appeal can be processed.
Online Form
Grievance
If you would like to submit a concern regarding a quality of care issue, complete the attached form and return it to United Concordia's Grievance Unit. You can complete it online or print the form and mail/fax it to United Concordia.
Online Form
Fraud Complaint Form
If you believe a dentist or entity has received insurance money through the submission of a false claim, you should report this information to the Special Investigations Unit (SIU).
Online Form Download
DD Form 2813 (Guard Reserve - Dental Readiness Classification)
The DD Form 2813, DoD Active Duty/Reserve Forces Dental Examination, will be used to assist the TDP-enrolled National Guard/Reserve forces in documenting member dental health.
Download
Nominate My Dentist
If you would like to nominate your dentist for participation with United Concordia, please submit the Nominate My Dentist form.
Online Form
Contact Us (Customer Service form -OCONUS, CONUS)
Use this form to submit a question to a United Concordia representative regarding the TDP or your benefits.
Online Form
 
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