Medicare Providers

Delta Dental of Illinois follows guidelines from the Centers for Medicare and Medicaid Services (CMS) to deliver essential educational materials to our provider network, ensuring high-quality, value-driven care for our members. For full Medicare Advantage requirements, please see the Participation Rules and Regulations in the Delta Dental of Illinois dentist portal.

---

Annual Training Requirements

All participating providers must complete annual training in:

• Fraud, Waste, and Abuse (FWA)
• Cultural Competency

These trainings support effective communication across diverse patient backgrounds.

After completing the required trainings, please submit your acknowledgment using the online or printable form below.

Step One: Complete Training	Step Two: Attest to Training	Additional Resources
Fraud, Waste, and Abuse (FWA) Training	Annual Certification Printable Form	Medicare Contract for Providers
Cultural Competency Training	Annual Certification Online Form	Medicare Advantage  Frequently Asked Questions for Providers

If you have any questions, please contact Delta Dental of Illinois Provider Relations at 630-718-4990 or email us at medicareadvantage@deltadentalil.com.

---

Policies and Procedures for Providers

As an Enterprise Medicare Advantage Provider, you must provide either the Enterprise’s Code of Conduct and applicable Compliance program policies or your own comparable code of conduct and applicable compliance program policies to all your employees and Downstream Entities.

You must also retain evidence of the distribution of the Code of Conduct for 10 years. DDIL’s Code of Conduct and Compliance Policies are available below:

Code of Ethics
DDIL & Affiliated Companies Compliance Program

---

Peer-to-Peer Discussion

Treating dentists can request a 20-minute peer-to-peer discussion with a dental consultant to clarify adverse clinical determinations based on medical necessity or clinical appropriateness. Anyone in the provider’s office may submit the request form, but only the treating dentist can participate in the discussion.

Please note:

• This is not an appeal and will not change the original determination. At this time, this service is limited to peer-to-peer discussions related to Medicare Advantage dental claims only.
• Contractual issues (exclusions, limitations, benefit exhaustion) are not eligible.

Request a peer-to-peer discussion here