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United Concordia TRICARE Dental Program fax number

(717) 635-4565

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Claims Submissions (TRICARE Dental Program)

Used for: TRICARE Dental Program CONUS claim submissions; submission of CONUS member claim forms

Fax destination details

Department
Claims Submissions (TRICARE Dental Program)
Purpose
TRICARE Dental Program CONUS claim submissions; submission of CONUS member claim forms
Form
Form 5730 — General TRICARE Dental Program CONUS Member Claim Form
Address
CONUS Claims Submissions: P.O. Box 69451, Harrisburg, PA 17106-9429

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Complete sponsor and patient details, service/procedure information, and signed attestations as required by the form; submit via fax to the CONUS fax number 717-635-4565

Official form instructions are published as a downloadable file on the organization's website.

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