Transcript NARMC Region - Missouri National Guard
Active Duty Dental Program
MAJ Mary-Frances McBain Health Services Officer, ARNG NGB-ARS
29 Jun 09 The National Guard – Always Ready Always There
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
Agenda
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Purpose What is Active Duty Dental Program (ADDP)?
Geographical Areas of Service Claims Steps to Accessing Care Appealing a Bill Tutorial Summary Conclusion
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
2
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
Purpose
To familiarize Leaders and Soldiers with the new process to access dental care under the Active Duty Dental Program
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
3
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
What is ADDP?
(1 of 2)
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Beginning 1 Aug 09, the ADDP will provide authorized private sector dental benefits under two distinct components for ARNG Soldiers ADDP is available to Soldiers who are either
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referred from a Dental Treatment Facility (DTF), or reside and work outside the catchment area
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duty location > 50 miles from a military DTF under the Remote Active Duty Dental Program (Remote ADDP) Line of Duty (LOD) care will also fall under this program
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
4
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
What is ADDP?
(2 of 2)
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The ADDP is designed to augment, not replace, dental care provided in military DTFs United Concordia pays dentists for authorized dental care
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Treatment must be provided by a United Concordia network dentist in order to be eligible for payment, unless otherwise designated by the Department of Defense (DoD)
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Replaces Military Medical Support Organization (MMSO) Dental Program, effective 1 Aug 09
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
5
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
Geographical Areas of Service
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Dental care under the ADDP will be available in the United States, U.S. Virgin Islands, Guam, Puerto Rico, America Samoa, and the Northern Mariana Islands United Concordia offers an extensive dental provider network of more than 59,000 dentists nation-wide
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
6
• •
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
Claims
United Concordia’s network of over 59,000 dentists will submit ADDP claims to United Concordia for payment All ARNG Soldiers eligible for the ADDP program must receive dental care from a United Concordia network dentist to be eligible for payment
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Claims will be paid for those areas where there are no available network dentists as determined by United Concordia
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
7
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
Steps to Accessing Care
(1 of 4)
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Remote ADSMs may personally coordinate their routine covered dental procedure as long as the dental treatment is less than $500 per procedure or appointment or the cumulative total is less than $1,500 for treatment plans completed within a consecutive 12-month period To coordinate their routine dental care, remote Soldiers must get an Appointment Control Number (ACN) by completing an Appointment Request Form, prior to seeking care
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
8
• •
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
Steps to Accessing Care
(2 of 4) Soldiers go to the following website to access the appointment request form:
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www.addp-ucci.com
There are two options for Soldiers wishing to schedule appointments
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United Concordia Dental Care Finders can make the appointment for Soldiers if they select United Concordia in the “who will be responsible for scheduling this appointment” field on the form
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Soldiers can personally make an appointment with a United Concordia network dentist by selecting the ADSM option in the “who will be responsible for scheduling the appointment” field on the form
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
9
• • • •
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
Steps to Accessing Care
(3 of 4) It is important for Soldiers to remember they must wait until they receive the ACN from United Concordia before they can make their own appointments Additionally, making their own appointment requires a Soldier to Contact United Concordia with the dentist’s name, date and time of the appointment so their records may be updated
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Soldiers can do so by e-mailing United Concordia at [email protected] or calling 1-866-984-ADDP (2337) If a Soldier has difficulty getting an appointment within 21 days of request they need to contact United Concordia at 1-866-984-ADDP (2337) Soldiers can choose to wait more than 21-days for a specific provider and waive their right to an appointment within the required 21-days, if they choose
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
10
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
Steps to Accessing Care
(4 of 4)
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Specialty and other Private Sector Dental Care
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To receive treatment for specialty care or care over $500 or $1,500/12 consecutive months, Soldiers MUST have their provider:
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Go to the ADDP website Fill out the Authorization Request Form in the Civilian Dentist portal for electronic completion and submission by the dentist
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Upon authorization both the dentist and Soldier will be notified and an appointment can then be scheduled
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The determination of the authorization request can take from three to five business days
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
11
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
What to do if a Soldier Receives a Bill?
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If a Soldier receives a bill for failure to go to a United Concordia Network Provider:
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The Soldier may appeal the bill at: Appeals United Concordia Companies, Inc.
ADDP Unit – Appeals P.O. Box 69430 Harrisburg, PA 17106-9430
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
12
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
United Concordia
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United Concordia set-up web based tutorials available for Soldiers, units, and other POCs to become familiar with the new processes
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https://secure.addp ucci.com/ddpddw/adsm/tutorials.xhtml
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
13
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
Summary
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As of 1 Aug 09, the MMSO is no longer coordinating remote dental care Soldiers with LOD needs or in Remote Service Areas must use a United Concordia network provider for their dental needs as of 1 Aug 09 Leaders, units and TRICARE POCs can go to www. addp.ucci.com to obtain training on this new program
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
14
Individual Medical Readiness is a Team Effort… …to Conserve Fighting Strength
Conclusion
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This is a new program, and with any new program, there will be growing pains Please be patient with United Concordia as they grow with the Army National Guard as our newest team member
Office of the Chief Surgeon
MAJ McBain / NGB-ARS / 703-607-9066 / [email protected]
29 Jun 09
The National Guard – Always Ready Always There
15
Active Duty Dental Program
MAJ Mary-Frances McBain Health Services Officer, ARNG NGB-ARS
29 Jun 09 The National Guard – Always Ready Always There