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

If an out-of-network dentist will not file your claim, you need to:

1. Bring a copy of the proper claim form to your dentist
2. Request that your dentist complete the claim form
3. Submit the completed claim form, along with your 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)

You also have the option to have your dentist complete a standard American Dental Association (ADA) claim form (available through your dentist). Submit the completed ADA claim form, along with your itemized bill, to:

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

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