Filing a Piggyback Claim
How Are Claims Filed?
DENTAL CLAIMS must be submitted to United Concordia Dental no later than one year after the date the primary carrier paid the original claim.
Hearing Aid and Vision claims must be submitted to the CCPOA Benefit Trust Fund no later than one year after the date the primary carrier paid the original claim.
All claims must have the following information:
- Participant’s name
- Last 4 of SSN,
- Patient’s name,
- Date of service,
- Services rendered,
- Charges for each service.
DENTAL Claims :
United Concordia Dental - Dental Claims
PO Box 69421
Harrisberg, PA 17106-9421
Customer Service: 1-844-789-1713
HEARING AID & VISION Claims :
CCPOA Benefit Trust Fund
2515 Venture Oaks Way
Suite
200Sacramento, CA 95833-4235
Customer Service: 916-779-6300
The following is a brief description of how to submit a claim:
Special title treatment
Dental Claims: You or your dentist must submit an itemized claim and an itemized primary insurance statement (EOB) to United Concordia Dental for reimbursement.
Vision Claims: Ask your eye care provider for an itemized statement of your out-of-pocket expenses and submit the statement to the CCPOA BTF for reimbursement.
Active: Piggyback Vision Claim Form
Retired: Piggyback Vision Claim Form
Hearing Aid Claims: Once an attending physician writes a prescription for the hearing aid device and the device has been purchased, submit a copy of the itemized statement and copy of the prescription to the CCPOA BTF for reimbursement.