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DeltaCare Transition Information for Providers

Effective March 1, 2026, Delta Dental of Illinois transferred administration of DeltaCare IL to Delta Dental Insurance Company (DDIC), a subsidiary of Delta Dental of California. DDIC has managed the DeltaCare USA network and national plan administration—including actuarial, underwriting, and network operations—for nearly two decades. This change aligns all the DeltaCare plans we offer with the same proven processes used for national DeltaCare plans across all Delta Dental member companies.

What Do You Need To Know?

Important Deadlines:

All encounters and specialty claims with dates of service prior to March 1, 2026, must be received by March 31, 2026 to be eligible for payment. 

  • Starting March 1, 2026: All claims and encounter documentation for dates of service on or after this date must be submitted through DDIC’s Provider Tools portal, where you can also access DeltaCare USA rosters and the handbook. As a courtesy, any submissions mistakenly received by Delta Dental of Illinois between March 1 and March 31 will be forwarded to DDIC on your behalf. Submissions received after March 31 will be rejected and must be resubmitted directly to DDIC. For more information and resources about Provider Tools, visit www1.deltadentalins.com/provider-tools

We value our partnership and are committed to making this transition as smooth as possible. If you have questions about capitation payments, claim or encounter submissions, referrals and specialty care, or other transition details, please review the FAQs below. 

DeltaCare Transition Provider FAQs

  • Can I continue to use my DeltaCare IL 3-digit facility number?

    No. While there will be a process to link a member’s 3-digit Illinois facility number, provider offices should use their current assigned 6-digit DeltaCare USA number, which can be found on Delta Dental Insurance Company’s Provider Portal at www.deltadentalins.com.

  • Are there any important deadlines I should be aware of for submitting claims and encounters?

    Yes. All encounters and specialty claims with dates of service prior to March 1, 2026, must be received by March 31, 2026 to be eligible for payment. 

    Starting March 1, 2026:  All claims and encounter documentation for dates of service on or after this date must be submitted through DDIC’s Provider Tools portal, where you can also access DeltaCare USA rosters and the handbook. As a courtesy, any submissions mistakenly received by DDIL between March 1 and March 31 will be forwarded to DDIC on your behalf. Submissions received after March 31 will be rejected and must be resubmitted directly to DDIC.

  • Will the DeltaCare IL plan numbers remain the same?

    Yes, the DeltaCare IL plans and plan numbers are not changing during this administration transition.

  • What is Utilization‑Based Assignment?

    Members are encouraged to select a primary care facility during open enrollment. Members who do not make a selection will remain unassigned until they either choose a facility themselves or receive non‑emergency care for the first time at a primary care facility. This process is known as Utilization‑Based Assignment.

    Utilization‑Based Assignment assigns unassigned members to a general dentist based on care delivered rather than at enrollment. Introduced with DeltaCare® Modernization in 2024, this approach better aligns member assignment with established patient care relationships. While members may still contact the DeltaCare USA Contact Center to request assignment to your office, this is no longer required.

  • How does Utilization-Based Assignment work?

    If a DeltaCare USA member is unassigned to a primary care facility at the time of service:

    • The facility delivers qualifying general dentistry services.
    • The facility submits a qualifying claim or encounter.
    • The member will then be assigned to the facility as their primary care facility.
    • The member will receive a notification confirming the assignment.

    What does not qualify:

    • Pre-treatment estimates and preauthorizations will not result in member assignment.
    • Emergency or limited services as outlined in the Dentist Handbook. The emergency treatment referral process will apply.
  • How can I check a member’s eligibility and assignment status?

    Member eligibility is available through Provider Tools.

    Your facility can verify a patient’s eligibility and confirm assignment status by selecting My Patients, then New or Returning Patient to:

    • Verify eligibility
    • Confirm assignment status

    If the eligible patient is already assigned to your facility, you will be able to:

    • View eligibility and benefits
    • Submit claims and encounters as usual

    If the patient is assigned elsewhere:

    • When you click the link to view eligibility and benefits, the assignment status will say: “Please ask the patient to select your facility.” As a result, you will not be able to submit claims or encounters.

    Members may change their primary care facility through their online account, or by calling Delta Dental Customer Service. If your facility treats a member who remains assigned to another facility, claims or encounters may be denied.

  • Who do I contact for questions, assistance or escalated issues?

    For assistance, questions or concerns, contact the DeltaCare USA Provider Concierge at 1-800-592-0156 or providerconcierge@delta.org. Access the DeltaCare USA Dentist Handbook in the Reference Library through Delta Dental Insurance Company’s Provider Tools portal at www.deltadentalins.com to review current policy and procedures, how to submit claims/encounters, review specialty referral guidelines and compensation policies, as well as an overview of our online Provider Tools capabilities.

DeltaCare Transition Provider FAQs - Rosters

DeltaCare Transition Provider FAQs - Claims, Payments, Capitations, Encounters, etc.

DeltaCare Transition Provider FAQs - Specialty Care & Referrals

  • When are specialty care referrals required?

    Contracted General Dentists must refer assigned patients to participating specialty providers when referral criteria in the Dentist Handbook are met.

    Referrals are required for:

    • Endodontics
    • Periodontics
    • Oral Surgery
    • Orthodontics
  • How do I submit a specialty referral?

    The DeltaCare USA Specialty Care Direct Referral Form must be completed and used to make a referral. The form is available online at www1.deltadentalins.com/ dentists/administrative-forms.html. The form may be photocopied and duplicated in your office as needed.

  • Do pediatric patients need a referral to see a pediatric dentist?

    No. Children through age 13 may go directly to a network pediatric dentist without a referral from a Contract General Dentist. 

    If currently assigned, the pediatric member will be removed from the primary care facility once a claim for pediatric specialty care is received or a member requests assignment. Pediatric Dentists serve as the primary care facility during this period.

    At age 14, members transition back to care through a primary care General Dentist facility either through utilization-based assignment or member request. Exceptions for medical conditions, regardless of age limitation, will be considered on an individual basis.

  • Can pediatric dentists make specialty referrals?

    Yes. Pediatric dentists may directly refer pediatric patients to other specialists (such as orthodontists).

    • Standard referral guidelines apply and are outlined in the Dentist Handbook.
    • No General Dentist involvement is required while the child is eligible for pediatric care (through age 13).

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