Claims
Dentists in United Concordia's Advantage Plus Network will submit claims for your employees. When using an out-of-network dentist, they may be required to complete and submit claim forms.

If an out-of-network dentist will not file an employee's claim, he or she will need to:

1. Bring a copy of the proper claim form to the dentist
2. Request that the dentist complete the claim form
3. Submit the completed claim form, along with the itemized bill, to the address at the top of the form

(All forms require Adobe Acrobat for download)

Standard Claim Form
Standard Claim Form (New York only)

The employee will also have the option to have his or her dentist complete a standard American Dental Association (ADA) claim form (available through his or her dentist). They can submit the completed ADA claim form, along with the itemized bill, to:

United Concordia Companies, Inc.
P.O. Box 69416
Harrisburg, PA 17106

Student Dependent Forms
Standard Dependent Attendance Report
Standard Drpendent Attendance Report (New York only)