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  • Standard Claim Form - United Concordia

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MEMBER DENTAL CLAIM FORM Please submit claim to: HEADER INFORMATION 1. Type of Transaction (Mark all applicable boxes) ? Statement of Actual Services ? Request for Predetermination/Preauthorization.

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Providing dental coverage to the military and federal employee communities for over 20 years.

Current Disaster Alerts: 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.

The TRICARE Dental Program (TDP) is a voluntary dental plan. Sponsors can enroll through the Beneficiary Web Enrollment website. You can enroll if you're a: Family member of an active duty service member.

The TRICARE Dental Program (TDP) is a worldwide dental care plan offered to eligible beneficiaries by the Department of Defense through the Defense Health Agency. United Concordia administers the TDP and is committed to help you and your loved ones enjoy good oral health through convenient, cost effective care.

If you can't locate a network dentist, call 1-866-984-2337.

Concordia Preferred is a traditional PPO plan. Therefore, you have the freedom to visit any dentist. Coverage rates tend to be higher at in-network dental offices, such as Dream Dental.

If you'd like to speak with a United Concordia Representative, please give us a call: Call United Concordia: CONUS Toll Free: 844-653-4061.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232