Frequently Asked Questions
Why are claims payments on a lag?
How can I save with a Delta Dental Network Dentist?
How do I know if my dentist is a Delta Dental PPO or Premier dentist, and if not, how can I find a dentist who participates in either network?
What if I choose a dentist who doesn’t participate in the Delta Dental PPO or Delta Dental Premier network?
How do I get the most from my dental benefit plan?
How can I obtain claim and benefits information?
My dentist does not participate in a Delta Dental network. How can I nominate him/her for network membership?
How does Delta Dental of Illinois handle coordination of benefits (COB)?
When Do I Need a Predetermination of Benefits?
How Do I Submit a Claim?
Where Can I Find Oral Health Information?
How Can I Check Status of a Claim?
Answers to above questions appear below:
Why are claims payments on a lag?
Please be advised that the State of Illinois group plans are self-funded. This means that claims are paid by the State as funds are available. Currently, reimbursement time for network dentists is different than that for non-network dentists as indicated here.
Claim payments are made when funding has been approved from the State for claims that are received and processed through specific dates.
How can I save with a Delta Dental Network Dentist?
Dentists who participate in Delta Dental PPO and Delta Dental Premier networks agree to accept an allowed fee as payment and cannot charge you the difference between his/her submitted fee and the allowed fee. Delta Dental PPO and Premier network dentists cannot bill you upfront for any charges other than applicable deductible and coinsurance amounts.
With your Schedule of Benefits, a non-network dentist can charge you for the difference between his/her submitted amount and the Schedule of Benefits amount. Click here to understand why.
How do I know if my dentist is a Delta Dental PPO or Premier dentist, and if not, how can I find a dentist who participates in either network?
To find a network dentist, click here. You have access to Delta Dental PPO and Delta Dental Premier. (Please note: DeltaCare USA is a dental HMO product and does not apply to your plan.) Click here for help finding a network dentist.
You can also call our Customer Service department, available 8:30 a.m. to 5:00 p.m. Monday through Friday, Central Standard Time or utilize the automated phone system, available 24 hours a day, seven days a week, at 800-323-1743 (press 5 during business hours for a live Agent).
What if I choose a dentist who doesn’t participate in the Delta Dental PPO or Delta Dental Premier network?
Our plan gives you the freedom to go any licensed dentist, but you may pay more if you go to a dentist who doesn’t participate in Delta Dental’s PPO or Delta Dental Premier network. Since the amount charged by non-network dentists are often higher than the Delta Dental of Illinois allowed fees that network dentists accept as payment in full, your out-of-pocket expenses may be greater, and the State’s claim dollars may be higher. (Please note: DeltaCare USA is a dental HMO product and does not apply to your plan.)
How do I get the most from my dental benefit plan?
Get treatment from a Delta Dental PPO or Delta Dental Premier network dentist. Here’s why.
How can I obtain claim and benefits information?
You can view eligibility, benefit, and claim information any time through the Member Connection on our website. You must register for the Member Connection. To register you will need the primary subscriber’s first and last name (it should be entered exactly as when you enrolled for coverage, for example, Richard rather than Rich), the primary subscriber’s member ID number (in most cases, the Social Security number) and the primary subscriber’s date of birth. You can also call our automated phone system at any time at 800-323-1743 for information (press 5 during business hours for a live Agent).
You can always speak with a Delta Dental of Illinois customer service representative during normal business hours, 8:30 a.m. to 5:00 p.m. Monday through Friday, Central Standard Time.
My dentist does not participate in a Delta Dental network. How can I nominate him/her for network membership?
You may nominate your dentist by completing the Dentist Referral Form. Or, call our customer service department and we will send him/her information on how to apply for membership. Dentists must meet our credentialing criteria to be accepted into our networks.
How does Delta Dental of Illinois handle coordination of benefits (COB)?
COB information is reviewed on a claim-by-claim basis. Delta Dental of Illinois systematically screens electronic and paper claims as entered to identify if an enrollee has dual coverage. Claims that indicate the presence of other coverage or claims for families flagged with prior COB are subject to investigation. If the processing system already has the enrollee’s COB information loaded, the claim is automatically processed based on the plan’s COB rules (i.e., standard or non-duplication). If it is determined that Delta Dental of Illinois is the secondary carrier, a code is entered in the appropriate family member’s files that causes future claims to process according to the plan’s COB rules.
When Delta Dental of Illinois has been identified as the secondary carrier and a claim is received without primary carrier information, the claim is denied requesting the other carrier’s EOB. Payment will be issued upon receipt of this information.
The name and address of the other carrier is stored in notes attached to the enrollee’s record in our system. A flag indicating whether that coverage is primary or secondary is maintained separately for each enrollee.
When Do I Need a Predetermination of Benefits?
It is not required, but we recommend that you ask your dentist to predetermine services over $200. If your dentist recommends a certain procedure that will cost over $200, ask him/her to determine what the amount will be in advance of performing the procedure so you have a clear understanding of what you will owe. This way, you and your dentist know up front how much will be covered under the benefit program and how much you will be required to pay for the service. A pre-determination of benefits is not a guarantee of benefits.
How Do I Submit a Claim?
Network dentists automatically submit claims to us. If you use a non-network dentist, you may have to file your own claim form. You can find claim forms on our website.
Claims Mailing Address
P.O. Box 5402
Lisle IL 60532
Where Can I Find Oral Health Information?
Be a smart mouth. Visit www.deltadentalil.com/oral-health today to see how Delta Dental of Illinois ensures that you and your family enjoy the benefits of good oral health.
How Can I Check Status of a Claim?
You can call our automated phone system/IVR or log on to our Member Connection to access claim information anytime, anywhere.