The Front Lines of the Front Desk: A Field Manual on TRICARE

Navigating the TRICARE Dental Program (TDP) doesn’t require a security clearance, but it does require knowledge of the program itself. Managed by United Concordia, the TDP functions a lot like your standard civilian PPO — but with a military twist. For active-duty families, the government picks up 60% of the premium, leaving the beneficiary with the remaining 40%.

How does enrollment work, and what do the benefits look like?

Unlike active-duty service members (who are covered automatically under military dental care), their families have to voluntarily enroll in the TDP, but only the military sponsor (or someone with Power of Attorney) can initiate enrollment. To prevent people from enrolling in the program just to get a crown and then go MIA, sponsors must have at least 12 months of service remaining to sign up. Additionally, once they’re in, they’re committed to coverage for a minimum 12-month period.

As far as benefits are concerned, the breakdown looks like this:

• Annual Maximum: $1,500 per person, per contract year.
  • Diagnostic and preventive services do not count toward that $1,500 annual maximum. This encourages regular dental checkups and the completion of preventive services.
• Orthodontic Coverage: Adult orthodontics is typically excluded. When covered for children who meet the clinical necessity criteria, the lifetime maximum is $1,750.
• Accidental Injury: An extra $1,200 annual max for accidents that doesn’t touch their regular $1,500 limit.

When it comes to billing, remember that the TDP functions similarly to what you are likely used to.

When it’s time to submit a claim to United Concordia, you will use the sponsor’s Social Security Number or their DoD Benefits Number as their ID number. If you’re a network dentist, you’re required to accept assignment of benefits – payments will come directly to the office. If you’re out-of-network, you can choose to have the check sent to you or the patient. Getting paid directly is typically the winning strategy for most offices, as it helps to avoid having to send out a search party for payments.

Now, is it necessary to submit a pre-authorization for treatment outside of diagnostic and preventive services? For things like fillings, cleanings, and “simple” extractions, you can usually just file the claim straight away with no prior authorization needed. However, call for backup – by way of a pre-authorization – in these scenarios:

• Orthodontics: Almost always needs a treatment plan review.
• Implants & Perio Surgery: Obtain a pre-treatment estimate to ensure you’ve met the medical necessity documentation requirements.
• Hospitalization or IV sedation: If you’re heading to the OR or using IV sedation, prior authorization through TRICARE Medical might be needed to assist with the facility and/or anesthesia fees.

Coordination of benefits with TRICARE is usually fairly straightforward.

Generally speaking, TRICARE is the secondary payor when other insurance is involved. If the patient has a civilian job with dental insurance, that plan is anticipated to pay first. The exception to that – and the instance where this can get tricky – is if the patient has a FEDVIP (Federal Employees Dental and Vision Insurance Program) plan, in which case, you’ll want to check the specific FEDVIP coordination rules.

Serving patients enrolled in the TRICARE Dental Program can be a rewarding experience for dental office team members. By understanding the specifics of the 12-month enrollment commitment, leveraging the fact that preventive care doesn’t touch the $1,500 annual maximum, and knowing when to submit for a pre-authorization or pre-treatment estimate, you can provide seamless care to the family members of those who serve our country. Visit our chapter on the TRICARE Dental Program in the 2026 edition of Dental Administration with Confidence for more information.

Source:

Practice Booster (2026). Dental Administration with Confidence (pp. 92-94). 2025 eAssist Publishing, LLC.