What forms do Mutual of Omaha and United Concordia require for producer appointments?
Is Web Enrollment available?
Where can I get a complete provider directory for my client?
Are plan provisions available on-line?
How can I help my client get new or additional ID cards for their employees?
Can ID cards be mailed directly to me instead of going to the client or employee?
Who do I contact for specific claim questions?
Who do I contact for eligibility and billing issues?
What is the process for adding or removing a dependent?
What is the claim appeal process?
What forms do Mutual of Omaha and United Concordia require for producer appointments?
A packet of forms is available through your Mutual of Omaha service representative or through Producer Snapshot on www.dentabenefits.com, Producer Appointment Information and Forms.
This packet includes Appointment Requirements and Commission Payment Policy, and Authorization for Disclosure, a Producer Information Checklist, Producer Information Form, Certifications and Authorization to Obtain Investigative Consumer Report, Producer Agreement, and W9 form. Also included in the packet will be any state specific forms required by the group situs state.
Note: All producers and/or agencies are required to be appointed by United Concordia in the state where the client group is sitused.
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Is Web Enrollment available?
Yes. Our online administration features give you the power to enroll new employees and make changes that immediately register to your account. Our secure web enrollment system is an Internet-based software program, available at no additional cost, which allows you to access and/or update eligibility and enrollment information housed on Mutual of Omaha’s system. Web enrollment requires a personal computer, an Internet service provider and a web browser of version 4.0 or greater. Updates are made in real-time, and all entries and changes are validated against your specific plan provisions to ensure accuracy.
Where can I get a complete provider directory for my client?
Note: Contact your Mutual of Omaha Sales or Service representative for a Login ID and Password.
All directories are maintained on www.dentabenefits.com. Go to 'Producer Snapshot', 'Plan Administration Resources', and Provider Directory.
There are three separate search options available. They include:
- A complete directory for a given state
- An address based directory using a home or work address as the starting point
- By specific city (up to three states can be selected, with multiple cities with each state)
Follow the prompts for designing your directory. Provide the email address to which the completed directory is to be sent.
Note: Depending on your selection criteria and the speed of your Internet connection, processing could take up to 24 hours and the directory file could be of considerable size.
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Are plan provisions available on-line?
Yes. The employer may access their specific plan information through www.dentabenefits.com, 'Employer', 'Plan Administration Resources', Employer Access. As this is a secured area of the website, the employer will need to set up a Login ID and Password.
Individual employees may also access their plan provisions on-line through 'Member', 'My Dental Benefits'. They, too, will need to set up Login ID and Password to access this area of the website.
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How can I help my client get new or additional ID cards for their employees?
Due to HIPAA regulations and the Privacy Act, the member will need to request new or additional ID cards themselves.
If the employee already has a card and would like additional cards, these can be ordered via My Dental Benefits. The employee will need to have the Identification Number (beginning with 'N') printed on their ID card to order through the web site. If they do not have their 'N' number, they are required to call Customer Service to make their request.
If the entire group is looking for replacement cards, you will need to work through your Mutual of Omaha service representative to document the need for the reprint.
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Can ID cards be mailed directly to me instead of going to the Client or employee?
All ID cards are either mailed directly to the employer or to the employee. Third-party mailings are not supported.
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Who do I contact for specific claim questions?
United Concordia in Harrisburg, PA, administers all dental claims for the DentaBenefits plans. All claim questions should be directed to their Customer Service team at 866-454-3190.
With the new Privacy Laws and HIPAA requirements in place, it is best if the employee makes the inquiry to UCCI themselves. United Concordia is bound by law not to reveal or discuss Protected Health Information (PHI) from anyone other than the individual in question. If you as the Plan Administrator make a request regarding PHI, UCCI may not be able to provide you with the information.
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Who do I contact for eligibility and billing issues?
Your Mutual of Omaha Service Representative can assist you, or you may call the Centralized Service Team handling your state:
| Eastern Region |
Central Region |
Western Region |
| 800-769-7159 |
800-369-3809 |
800-655-5142 |
| AL, DC, DE, FL, GA, KY, MA, ME, MS, NC, NH, NJ, NY, PA, RI, SC, VA, VT, PR, VI |
AR, IL, IN, KS, LA, MI, MN, MO, ND, OH, OK, TX |
AK, AZ, CA, CO, HA, IA, ID, MT, NE, NM, NV, OR, SD, UT, WA, WY |
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What is the process for adding or removing a dependent?
A dependent can be added or removed from the plan only at open enrollment or if there is a Life Change Event as stated in the policy document. Dependent Life Change Events considered after initial employee enrollment include:
- Birth
- Adoption
- Court order of placement or custody
- Change in student status
- Marriage
If the client has a Section 125 plan, Loss of Coverage under another plan is also a Life Change Event.
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What is the claim appeal process?
United Concordia provides full opportunity for eligible parties to appeal benefit decisions on post-service claims. The decision may be appealed to our one level appeal process within 180 days of receipt of the benefit determination, unless otherwise regulated by specific state legislation. To appeal a claim, there must be an amount in dispute, a denial reduction or termination of or failure to make payment (in whole or part) based on a determination of eligibility.
All appeals must be made in writing and should be submitted to:
United Concordia Companies, Inc.
P.O. Box 69416
Harrisburg, PA 17106
The appeal should include information not originally submitted for review. The additional information will be considered and a decision made.
Written notification will be issued to the dentist and subscriber within sixty (60) days of receipt of the appeal identifying what action, if any, will be taken. The appeal decision will include the following information:
- The specific reason for the appeal decision;
- Reference to specific plan provisions on which the decision was based;
- A statement that the claimant is entitled to receive upon request and free of charge, reasonable accessibility to and copies of all relevant documents, records, and criteria, including an explanation of clinical judgment on which the decision was based;
- A statement of the claimant's right to bring a civil action under ERISA.
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