Active Duty Officer Dental Program
On May 1st, 2005 United Concordia Companies Inc. (UCCI), in partnership with the Department of Health and Human Services, assumed administration of the PHS Dental Program. What does this mean to you as an active duty officer? Your dental entitlements will remain the same, the only changes are:
- UCCI will process all PHS dental claims
- UCCI will be responsible for all pre-treatment determinations (e.g. authorization for complex procedures such as periodontal surgery and multiple crowns)
- The appeals process for denied claims will be initiated by you or your authorized party to UCCI
- UCCI will provide an Explanation of Benefits (EOB) to officers and their dental provider for each episode of care
(You Do Not Have To Switch To A United Concordia Dental Provider)
If you have an established relationship with a dentist who is not a UCCI network provider, you may continue to seek dental care from that individual. UCCI will continue to pay claims on the current PHS maximum allowable fee schedule at 100% (same fee schedule as in the past). Non-network providers may request that you pay the entire fee at the time of service. In this case, it is the officer’s responsibility to submit the claim to UCCI for reimbursement.
If you currently see an UCCI dental provider, they will be reimbursed at 100% per UCCI’s network maximum allowable fee schedule and will submit claims to UCCI on your behalf.
Your PHS dental entitlements include coverage for:
- Diagnostic and preventive services (exams, cleaning and x-rays)
- Restorative Services (silver and tooth colored fillings)
- Endodontics (root canals)
- Prosthodontics (crowns)
- Periodontics (gum surgery)
- Oral Surgery (extractions)
(Orthodontics and Cosmetic Dental Services Are Not Covered)
Diagnostic and preventative services include exams, cleanings and x-rays – see below.
Exams: Three routine oral evaluations are eligible during a twelve (12) consecutive month period. However, only two oral evaluations may be performed by the same office in the 12 month period.
Cleanings: Two routine cleanings are eligible in a twelve consecutive month period. Two topical applications of fluoride are eligible in a twelve consecutive month period.
X-rays: One full mouth radiograph series or panoramic radiograph is eligible in any 36 month period. One occurrence of bitewing radiographs, consisting of up to four bitewing radiographs per occurrence, are eligible during a 12 consecutive month period. An occurrence is a number of bitewings (2, 3 or 4) taken on the same date of service.
For detailed information regarding the PHS Dental Program please register for My Dental Benefits through UCCI’s PHS website. My Dental Benefits allows you to view benefits and eligibility information, check on the status of a claim, view past treatment information, request a new ID card and find a provider in your network, at any time of day to suit your schedule.
To register for My Dental Benefits:
Visit
UCCI’s website
"Select Client’s Corner" (bottom left corner)
Under the letter "P" select "Public Health Service"
Under Online Service select "My
Dental Benefits"
Select "Register" (gray
box)
Click "OK"
Follow the instruction for completing the "Membership Registration Form"
Please utilize the following contact information for any questions/concerns regarding your dental entitlements:
United Concordia Contact Information
Claims / Predeterminations and Written Inquiries:
United Concordia
PHS Customer Service
P.O. Box 69425
Harrisburg, PA 17106-9425Telephone Inquiries:
1-877-261-2379 (toll free)
1-717-260-6866 (toll)
Monday - Friday, 8 AM - 8 PM EST
E-mail Inquiries:
U.S. PHS Contact Information
MAB Dental Service Point of Contact
1-240-453-6089
CDC Health Benefits Advisor
LCDR Anissa Davis (770) 488-1869
Office of Commissioned Corps Personnel Website
ASH Dear Doctor Letter-Dental Providers (PDF, 87 KB)
ASH Letter to Officers-UCCI Transition (PDF, 91 KB)
Brochure-UCCI 2005 (PDF, 90 KB)
UCCI Letter to CC Officers (PDF, 146 KB)
UCCI PHS Claim Form (5578 PHS) Tips
It is very important to complete as much of the Dental Claim form as possible, to be sure we can promptly process the claims, and get reimbursements sent in a timely manner. However, there are certain sections that are more important than others in the Dentist Section of the claim form as follows:
- The dentist's name, address, phone number
- The dentist's Tax Identification Number (TIN)
- The procedures that are being performed
Please note: The dentist's signature is not required. Depending on the services being provided, UCCI may require radiographs for review.
UCCI is dedicated to have 90 percent of the Public Health Services dental claims processed within 14 calendar days, and 100 percent processed within 60 calendar days.
UCCI PHS Claim Form (PDF, 80 KB)