TRICARE Dental Program

Claims Submission Document (CONUS Service Area)

TRICARE Dental Program participating dentists will file claims on your behalf, but if you need to submit a dental claim, mail or fax the completed Dental Expense Claim Submission Document to United Concordia:

United Concordia
TRICARE Dental Program
P.O. Box 69451
Harrisburg, PA 17106

Claims Submission Document (OCONUS Service Area)

TRICARE Dental Program participating dentists will file claims on your behalf, but if you need to submit a dental claim, mail or fax the completed Dental Expense Claim Submission Document to United Concordia:
United Concordia
TRICARE Dental Program
P.O. Box 69452
Harrisburg, PA 17106

Department of Defense Active Duty/Reserve/Guard/Civilian Forces Dental Examination Form (DD Form 2813)

This form is used to help active duty and National Guard and Reserve members in documenting dental health for worldwide duty. It should be downloaded and given to the dental provider to complete.

Enrollment/Change Authorization

This form is used to enroll in the TRICARE Dental Program with United Concordia. To enroll, submit this form and mail it along with your initial monthly premium payment (check, money order or credit card) to United Concordia:

United Concordia
TRICARE Dental Program
P.O. Box 645547
Pittsburgh, PA 15264-5253

You will also use this form if you need to make changes to your existing TRICARE Dental Program enrollment.

 

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Last Updated 11/29/2019