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State of Illinois

** NEW INFORMATION – PLEASE READ ** 

IMPORTANT NOTICE FOR DENTISTS WITH PATIENTS COVERED BY THE STATE OF ILLINOIS DENTAL PLAN 

IMPORTANT NOTICE FOR STATE OF ILLINOIS DENTAL PLAN MEMBERS 

We are aware that a state budget was recently approved. What that means in terms of claims payments is yet to be determined. The State is a self-funded plan and as a result, we pay claims based on the State funding claims. We will advise our dentists and members as soon as we learn from the State what they plan to do.

Delta Dental of Illinois is pleased to be the administration of dental services for the State of Illinois Group Dental Plans, which consists of the Quality Care Dental Plan (QCDP), Local Care Dental Plan (LCDP) and the College Choice Dental Plan (CCDP) effective July 1, 2011

With the addition of the State of Illinois Group Insurance Dental Plans, DDIL and other Delta Dental member companies will insure and/or provide administrative services to two million enrollees in Illinois. The State joins our 5,000 Illinois business clients, including one-third of the Fortune 1000 companies headquartered in Illinois and more than 400 Illinois municipal and school district groups.

Please contact Professional Relations at pr@deltadentalil.com or 630-718-4990 for questions about network status or to join a network. Please direct questions about claims status or State of Illinois Group Dental Plans-specific questions to Customer Service at 888-224-0295.

Frequently Asked Questions

When did the State of Illinois Group Dental Plans transition to Delta Dental of Illinois?

July 1, 2011.

The State of Illinois Group Delta Dental of Illinois Dental Plans consists of the Quality Care Dental Plan (QCDP), Local Care Dental Plan (LCDP) and the College Choice Dental Plan (CCDP).

With the addition of these groups, Delta Dental of Illinois and other Delta Dental member companies will insure and/or provide administrative services to two million enrollees in Illinois. The State of Illinois Group Dental Plans joins our nearly 5,000 Illinois business clients, including one-third of Fortune 1000 companies headquartered in Illinois and more than 400 Illinois municipal and school district groups.

How does this affect dentists who treat State of Illinois Group Dental Plan enrollees?

For dates of service July 1, 2011 and after:

  • Claims will be processed timely by Delta Dental of Illinois;
  • Claims will be paid by Delta Dental of Illinois as funding is made available by the State;
  • Claims should be submitted to Delta Dental of Illinois electronically (use Delta Dental of Illinois payer ID# 05030) or mailed to: PO Box 5402, Lisle, IL 60532;
  • Enrollee calls will be directed to 800-323-1734 (press 5 for State of Illinois Group Dental Plans inquiries);
  • Dentist calls for State of Illinois claims and eligibility questions have a dedicated telephone line, 888-224-0295
  • All claim submissions and inquires for dental service dates prior to July 1, 2011, will be handled by the previous dental plan administrator, Humana CompBenefits at 800-999-1669;
  • Claims submitted to Delta Dental of Illinois with dates of service prior to July 1, 2011 will be denied.

What are the key differences between the Humana CompBenefits plan and Delta Dental of Illinois plan for State of Illinois Group Dental Plan enrollees?

The biggest change is the addition of the Delta Dental PPO and Delta Dental Premier networks.  The State of Illinois Group Dental Plans have paid claims based upon a fee schedule (Schedule of Benefits) for many years and will continue to do so.  However, to maximize savings for both for the State and its enrollees, the State now offers access to the Delta Dental PPO and Delta Dental Premier networks as of July 1, 2011.  

Additionally, for self-insured groups, Delta Dental of Illinois does not usually assign benefits to dentists who do not participate in our networks.  Therefore, if an enrollee uses a non-network dentist, Delta Dental of Illinois will reimburse the enrollee directly for covered services and the enrollee is responsible for paying up front for treatment rendered.   However, due to a recent change for the State of Illinois group, the enrollee now may elect to have reimbursement sent directly to a non-network dentist.  The enrollee must consent to authorize payment of benefits directly to the non-network dentist and the non-network dentist must agree to not collect any payment from the enrollee at the point of service other than any applicable fees such as deductibles, copayments and amounts over the Schedule of Benefits.  (Lag times for non-network claims will continue to follow timeframes posted on our website.)

Will State of Illinois Group Dental Plans continue to have a Schedule of Benefits?

Yes, but enrollees now have the benefit of Delta Dental's expansive dental networks. Enrollees can still go to any licensed general or specialty dentist, regardless of whether the dentist participates in Delta Dental PPO or Delta Dental Premier.

What has been communicated to impacted enrollees?

  • Delta Dental of Illinois will be is the new dental plan administrator; 
  • The benefits of using a Delta Dental network dentist, including the out-of-pocket savings that can be achieved by utilizing a network dentist;
  • Explanation of how claims are paid, including payment arrangements for Delta Dental network dentists and now how non-network  claims are paid, (enrollees are paid directly for non-network claims and enrollees are responsible for reimbursing the non-network dentist unless the enrollee assigns their benefits to a non-network dentist and the non-network dentist does not collect any payment from the State of Illinois enrollee at the point of service other than any applicable fees such as deductibles, copayments and amounts over the Schedule of Benefits).

Are enrollees being encouraged to use a network dentist?

Yes, enrollees are encouraged to use Delta Dental network dentists. If you are not currently a Delta Dental network dentist and wish to participate in our networks, please contact us by email at PR@deltadentalil.com, fax at (630)983-4085 or contact our Professional Relations department at (630) 718-4990.

How can enrollees find network dentists?

Enrollees can find participating network dentists through Delta Dental of Illinois's online network dentist search tool. Enrollees can access it directly at www.deltadentalil.com.

How will network vs. non-network claims be paid?

NETWORK DENTISTS:

Network dentists (dentists who are contracted to participate in Delta Dental PPO and/or Delta Dental Premier networks) will receive benefit payment directly from Delta Dental of Illinois for all patients covered by the State of Illinois Group Dental Plans, as they do now for all Delta Dental of Illinois enrollees.  The enrollee is only responsible for the applicable deductible, services not covered by the plan, amounts greater than the enrollee’s Schedule of Benefits but up to the dentist’s contracted network amount, and any amounts exceeding the annual benefit maximum.  In accordance with the network dentist agreement, enrollees cannot be charged upfront for any other amounts.   

The State is working with Delta Dental of Illinois to help support a network-based plan and is trying a new initiative:  expediting claim reimbursement to dentists.  The number of days between claim receipt and payment has been significantly reduced for network dentists. The number of days between claim receipt and payment has been reduced for State of Illinois Group Dental Plan non-network claims as well, but there is a difference in reimbursement time for network and non-network claims. The decreased reimbursement time will apply to the Quality Care Dental Plan, the Local Care Dental Plan and the College Choice Dental Plan for claims incurred after July 1, 2011 and the decreased reimbursement time will be listed on the State of Illinois enrollee website, Delta Dental of Illinois’ Dentist Connection and Delta Dental of Illinois’ “Faxbacks.”

NON-NETWORK DENTISTS:

For self-insured groups such as the State of Illinois Group Dental Plans, Delta Dental of Illinois usually does not assign benefits to dentists who do not participate in our networks.  Therefore, if an enrollee uses a non-network dentist, payments issued by Delta Dental of Illinois will be sent directly to the enrollee and the enrollee will be responsible for paying the dentist up front, if requested by the non-network dentist, for treatment rendered.  However, due to a recent change for the State of Illinois group, the enrollee may now elect to have reimbursement sent directly to a non-network dentist.  The enrollee must consent to authorize payment of benefits directly to the non-network dentist and the non-network  dentist must agree to not collect any payment from the enrollee at the point of service other than any applicable fees such as deductibles, copayments and amounts over the Schedule of Benefits.  (Lag times for non-network claims will continue to follow timeframes posted on our website.)

Automatic direct payment of benefits has long been an advantage enjoyed by dentists who participate in Delta Dental networks and an incentive for them to participate.  This automatic direct payment process for network dentists is not optional and cannot be redirected by the patient’s assignment on a claim form.

Is there a specific toll-free number for State of Illinois Group Dental Plans inquiries?

Yes, dentist inquiries should be directed to the Delta Dental of Illinois dedicated State of Illinois Customer Service Department number, at 888-224-0295.

How should claims be filed with Delta Dental of Illinois?

For dates of service July 1, 2011 and forward, claims should be submitted to Delta Dental of Illinois electronically (use Delta Dental of Illinois' payer ID# 05030) or by mail to PO Box 5402, Lisle, IL 60532.

For dates of service prior to July 1, 2011, claims and related inquiries will continue to be handled by Humana CompBenefits at 800-999-1669.

How are claim payments made?

Delta Dental of Illinois will process claims on a timely basis. As is current practice, claim payments will be released according to the claim process date and available funding as determined by the State. The State of Illinois is a self-funded plan and as such, Delta Dental of Illinois reimburses dentists once it receives funding from the State. Because funding from the State has been delayed, claims have been paid on a delayed basis.

The State is working with Delta Dental of Illinois to help support a network-based plan and is trying a new initiative: expediting claim reimbursement to dentists. The number of days between claim receipt and payment has been significantly reduced for network dentists. The number of days between claim receipt and payment for non-network claims has also changed, but there is a difference in reimbursement time for network and non-network claims.

When is a claim eligible for Late Payment Interest (LPI)?

Claims may be paid on a delayed basis. LPI will be paid in accordance with Illinois law. LPI is calculated beginning on the 31st day after receipt of a clean claim in the amount of 9% annually. Interest amounting to less than one dollar is not paid.

Will Explanation of Payments (EOPs) show late payment interest (LPI)?

No, EOPs will not show LPI. LPI will be issued on a separate check.

Is Delta Dental of Illinois handling claim run out?

No, all inquiries and claims with dates of service prior to July 1, 2011 will continue to be handled by Humana CompBenefits at 800-999-1669.

Is a Predetermination of Benefits Required?

No, but we recommend that dentists predetermine services over $200. This way, dentists and the enrollee will know up front how much will be covered under the plan and how much the enrollee will be required to pay for services. A pre-determination of benefits is not a guarantee of benefits.

How do I check eligibility and claim status?

Get real-time benefits and eligibility information and claim status on the Dentist Connection. You can also get this information through our interactive voice response (IVR) phone system at 888-224-0295. Through our IVR, you can also request a "FaxBack" by saying FaxBack at the prompt. FaxBack will send a fax with eligibility, benefit, and claim information for Delta Dental of Illinois patients. For an overview of the Dentist Connection and IVR capabilities, click here.

How is work in progress being handled?

Payment for treatment-in-progress is based on the service completion date, regardless of the type of treatment (except for orthodontia which is pro-rated, based on remaining treatment time).

When should a dentist or dental office contact Professional Relations?

Please contact Professional Relations at PR@deltadentalil.com or 630-718-4990 for questions about network status or to join a network. Please direct questions about claims status or State of Illinois Group Dental Plans-specific questions to Customer Service at 888-224-0295 for State of Illinois only.