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TRICARE Active Duty Dental Program _PowerPoint Training_

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					              Military Dental Treatment Facility
                      TRICARE
             Active Duty Dental Program
                          Training




     Presented by
 Janice Schoenhofer
Dental Benefits Advisor
  United Concordia
     316-789-0392

                                                   1
                    What is the ADDP?
•   New program that replaces dental claims processing previously provided by
    the Military Medical Support Office (MMSO) and other agencies.

•   Its purpose is to augment – not replace – dental care that is provided by
    Military Dental Treatment Facilities (DTF’s)

•   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 otherwise designated by United Concordia



                                                                                2
  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

                            160
                            140
                            120
            $ in Millions




                            100
                            80
                            60
                            40
                            20
                              0
                                  O1   O2   O3   O4      O5    O6   O7   O8
                                                 Fiscal Year




                                                                              3
Geographical Areas of Service

•   50 United States
•   Guam
•   Puerto Rico
•   U.S. Virgin Islands
•   American Samoa
•   Northern Mariana Islands.




                                4
              Who is eligible?
• Active Duty Personnel of 5 Uniformed Services
  who live and work within 50 miles of a military
  DTF
• 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
                                                     5
        ADSM Dental Readiness


• United Concordia will track dental readiness
  classification for all who utilize the ADDP.

• DTFs must indicate “current” and “expected”
  dental readiness on the Referral Form.




                                                 6
                        ADSM Benefits
• Benefits will be provided as specified in Attachment 2 of
  contract
Note: Frequency limitations noted in Attachment 2 do not apply to
      DTF referrals.

    – Attachment 2 is available in the DTF manual and on the Web site
      (www.addp-ucci.com) after 1 June 2009.

Specific processes (e.g., evaluation boards
for orthodontics and implants) are
not affected by the ADDP. Your current
procedures utilized by the Uniformed Services
still apply.



                                                                        7
                    EMERGENCY Dental Care
Emergency dental care procedures established by the DTF apply to all non-
remote ADSMs. They should contact their local military DTF for a list of
policies pertaining to emergency care.

  • Emergency dental care does not require a Referral or
    Appointment Control Number.

  • Non-remote ADSMs who are traveling (Leave or Duty
    related) do not require a Referral or ACN.

  • Not required to utilize a United Concordia dentist, but
    recommended. Follow-up care must be with a United
    Concordia network dentist.
                                                                            8
                           Claims
• All dental care received under the ADDP must
  be received from a United Concordia network
  dentist to be eligible for payment.


• Claims will also be paid for those
  areas where there are no available
  network dentists.
  (as determined by United Concordia)

                                                 9
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
   addpdcf@ucci.com.
• Extenuating circumstances may prevent the ADSM from
  cancelling within 24 hours of the appointment. If this
  occurs, they must call United Concordia to reschedule.
• ADSM should call United Concordia if they receive a bill for the
  missed appointment


                                                                     10
                         Appeals
• ADSMs are required to have a DTF Referral with an
  ACN (Appt Control Number) 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
• DTF’s discretion whether the appeal will be submitted or
  not. If decided to appeal, letter must be sent to United
  Concordia


                                                                     11
                              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
    (1-866-308-4138).

                                                                                           12
                      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
         military DTF or 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.


                                                                                               13
            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
    payment 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.


                                                      14
Steps to Referring ADSMs for Private
         Sector Dental Care
• After it has been determined private sector dental care is
  required, the DTF must accomplish the following steps to
  ensure timely access to a civilian dentist.

• Note: 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.

• The Dental Authorization & Referral Tracker (DART) system
  will be functional starting 1 August. Appointments for August
  1st and later can be made during the month of July by calling
  a United Concordia Dental Care Finder at 1-866-984-ADDP
  (2337).
                                                                  15
      Completing and Submitting a
        Referral Request Form
• Access the Referral Form through the ADDP Web site
  (www.addp-ucci.com) by clicking on the Government portal.




                                                              16
           Referral Request Form (continued)
• Click the Dental Authorization & Referral Tracker (DART) link on
  the left navigation bar.
• Log onto United Concordia’s DART system using the login ID and
  password provided by United Concordia.
• Click the Create New Referral button to open a new Referral Form




                                                               17
18
               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.

•   Make sure you send
    current X-rays with the
    ADSM to the civilian
    dentist. Or, make sure you
    authorize X-rays to be
    taken during the
    appointment.
                                                   19
            Making the Dental Appointment
                      3 Options
1. Let United Concordia make the appointment for the ADSM

   – Dental Care Finders (DCF) will coordinate within two (2) business
     days with 3 network providers to choose and will make the appt
     with the selected dentist for the ADSM.

   – UCCI ensures Access To Care to be maintained
       • 21 day for routine care
       • 28 day for specialty care
       • Unless the SM elects to wait for a particular provider (this should
         be noted in the “Notes” section of the Referral Form by the DTF

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


                                                                          20
  Making the Dental Appointment (continued)
2. The DTF can make the appointment
 - Within three (3) days of the request, the DCF will provide a list of
   3 network dentists.
 - If a specific network dentist is preferred, specify that on the Referral
 Form (located at the bottom)
      -- If the wait time is greater than the 21/28 day Access To Care
 requirement, the DTF must specify that the ADSM is willing to wait for
 that dentist in the “Notes” section of the Referral Form

 - The DTF can call a United Concordia network dentist directly and
 arrange the appointment. The DTF MUST notify United Concordia
 of the appointment date and time.



                                                                          21
  Making the Dental Appointment (continued)

3. ADSM can make their own appointment
   - Within three (3) days of the request, the DCF will provide a list of
     3 network dentists.

   - If ADSM has a specific network dentist they want to use, they can
   have the DTF specify that on the Referral Form
     -- If the wait time is greater than the 21/28 day they must have the
   DTF specify they will wait for that dentist in the “Notes” section of the
   Referral Form

   - The ADSM can call a United Concordia network dentist directly and
   arrange the appointment. The ADSM MUST notify United
   Concordia of the appointment date and time.
                                                                          22
     Modifying a Referral Form
• The ADSM will only receive the procedures
  prescribed on the Referral.
• No alternate procedures will be provided unless
  approved by you, 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 will need to modify the existing
    referral to include new procedures and/or remove procedures
    that the ADSM will no longer receive.

                                                                  23
        Modifying a Referral in the DART System
• You log onto the DART system. On the home page, click the Search
  Referrals button..




                                                                24
Modifying a Referral (continued)




                                   25
Modifying a Referral (continued)




                                   26
                 Data Warehouse
An online data warehouse houses all data files associated with the ADDP
contract including data concerning:

        •   Provider utilization
        •   Referrals
        •   Authorizations (for remote ADSMS)
        •   Claims processing
        •   Claims payment
        •   ADSM care and procedure data
        •   Incurred cost data
        •   Dental Classifications
The Data Warehouse is updated nightly and
available 24/7. The Claims Data is updated on a
weekly basis.

Online training and Webinars for the Data Warehouse will be available on
the website at www.addp-ucci.com. The web is live as of 1 Jun 09, and 27
webinars are available beginning July, 7th
       United Concordia Contact Information
ADDP Web site: www.addp-ucci.com              Claims
                                              United Concordia Companies, Inc.
Dental Care Finders/Customer Service          ADDP Claims
Phone: 1-866-984-ADDP (2337)                  P.O. Box 69429
Fax: 1-866-308-4138                           Harrisburg, PA 17106-9429
8 a.m. to 8 p.m. (ET) Monday through Friday
8 a.m. to 5 p.m. (ET) Saturday                Appeals
addpdcf@ucci.com                              United Concordia Companies, Inc.
                                              ADDP Unit – Appeals
Inquiries                                     P.O. Box 69430
United Concordia Companies, Inc.              Harrisburg, PA 17106-9430
ADDP Unit
P.O. Box 69430                                Grievances
Harrisburg, PA 17106-9430                     United Concordia Companies, Inc.
                                              ADDP Unit – Grievances
                                              P.O. Box 69430
                                              Harrisburg, PA 17106-9430


                                                                                 28
Questions




            29
      Remote Active Duty Dental
         Program (ADDP)

The Remote ADDP provides private sector dental
care to Active Duty Service Members (ADSMs)
who live AND work 50 or more miles from a
military Dental Treatment Facility (DTF).



                                                 30
              Early Activators
                             Or
  Members issued delayed-effective-date-active duty orders
(for more than 30 days in support of a contingency operation)

  Must use their DTF for their dental care and to access
            the ADDP through a DTF Referral
   If the SM is remotely located as part of the early
  activation, United Concordia will need the orders
      faxed to determine eligibility for the RADDP




                                                                31
     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.




                                                           32
Remote ADSM Steps to Accessing Care




                                      33
          Remote ADSM Steps to Accessing Care

• The Remote ADSM must wait until they receive the ACN from
  United Concordia before they can make their own appointments.

• Additionally, making their own appointment requires them to
  contact United Concordia with the dentist’s name, date and
  time of the appointment so their records may be updated.

• If they have difficulty getting an appointment within 21 days of the
  approval (receipt of the ACN) they can contact United Concordia for
  assistance at 1-866-984-ADDP (2337)

• They can choose to wait more than 21 days for a specific provider
  and waive their right to an appointment within 21 days.


                                                                      34
             Remote ADSM Steps to Accessing Care

Specialty and Other Private Sector Dental 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

•   Seeing a non-network dentist

•   If it is required by the Unit Commander to receive a Command Memorandum prior to
    implant and orthodontic specialty procedures, this should be submitted by the civilian
    dentist as an attachment to the completed Authorization Request Form, along with all
    appropriate diagnostic quality radiographs and any additional information that may be
    useful to justify the need for the requested treatment.

                                                                                        35
Remote ADSM Steps to Accessing Care




                                      36
 Remote ADSM Steps to Accessing Care

• The determination of the authorization request
  can take from to three to five business days.

• Upon authorization approval the ADSM and
  civilian dentist will be notified and an
  appointment can be scheduled to initiate care




                                                   37
       United Concordia Contact Information
ADDP Web site: www.addp-ucci.com              Claims
                                              United Concordia Companies, Inc.
                                              ADDP Claims
Dental Care Finders/Customer Service
                                              P.O. Box 69429
1-866-984-ADDP (2337)                         Harrisburg, PA 17106-9429
8 a.m. to 8 p.m. (ET) Monday through Friday
8 a.m. to 5 p.m. (ET) Saturday                Appeals
addpdcf@ucci.com                              United Concordia Companies, Inc.
                                              ADDP Unit – Appeals
Inquiries                                     P.O. Box 69430
United Concordia Companies, Inc.              Harrisburg, PA 17106-9430
ADDP Unit
P.O. Box 69430                                Grievances
                                              United Concordia Companies, Inc.
Harrisburg, PA 17106-9430
                                              ADDP Unit – Grievances
                                              P.O. Box 69430
                                              Harrisburg, PA 17106-9430


                                                                                 38
Questions




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