Third-Party Vendor Eligibility Inquiries

If your practice uses a third-party vendor to perform eligibility inquiries, please tell us which vendor you use by completing the form below. This will help us manage vendor access while minimizing disruption to your operations. Please note that setting up compliant data transfers with vendors can take time, though we will work as efficiently as possible.

All fields marked with * are required.

Provider Contact Information

Please enter the contact information for the dental office IT contact who can assist with this request, so Delta Dental of Illinois can reach out directly.

Dental Office Name *

Contact First Name *

Contact Last Name *

Contact Email Address *

Contact Phone Number *

Vendor Contact Information

Vendor Company Name *

Vendor Contact Email Address *

Vendor Contact Phone Number *

Agree to Terms of Use *

By submitting this form, I am agreeing to the Terms of Use.

Menu

I am a ...

Third-Party Vendor Eligibility Inquiries

Please enter the contact information for the dental office IT contact who can assist with this request, so Delta Dental of Illinois can reach out directly.

Choose Delta Dental of Illinois