Delta Dental Networks and Claims Information
In this section, you can access information on our network and other important claims information, like coordination of benefits, orthodontia payments, and assignment of benefits.
Delta Dental Networks and Claims Information
- How to Find a Network Dentist
- Network Overview
Delta Dental PPO and Premier networks are among the largest in the nation with more than 80 percent of participating dentists in one of our networks. That means better access, savings and protections. Learn more about our Delta Dental PPO Plus Premier network solution.
- Go PPO
Using a Delta Dental PPO dentist saves members money. With so many dentists to choose from, it’s normal (and smart!) for members to have questions about picking one that best fits their needs. Delta Dental PPO network dentists have the advantage. Here’s what you need to know to encourage members to Go Delta Dental PPO by showing how they can save. You may also review our flyer on why it's smart to GO PPO.
- Reimbursement In-network vs. Out-of-network
Dentists in the Delta Dental PPO network have agreed to accept Delta Dental’s established PPO fees as payment in full for services. On average, these fees are 30 percent less than what the dentist would typically submit for a claim. Delta Dental PPO network dentists have also agreed not to “balance bill” patients. That means they can’t bill members for the difference between what they usually charge and the Delta Dental established PPO fee. Visiting a Delta Dental PPO dentist means lower out-of-pocket costs and the best value for members.
Delta Dental Premier® is a safety net for our Delta Dental PPO network. Members will pay more out-of-pocket with a Delta Dental Premier dentist compared to a Delta Dental PPO dentist. However, members may save more money with a Delta Dental Premier dentist compared to a non-network dentist. Delta Dental Premier dentists agree to our maximum plan allowances as payment in full, which may be lower than what a dentist would typically charge. Delta Dental Premier dentists can’t bill members for the difference between what they would usually charge and the Delta Dental Premier maximum plan allowance.
Non-network dentists have not agreed to accept a lower fee as payment in full. The dentist can charge the difference between their usual fee and the allowed fee for out-of-network (this fee depends on your plan).
Access a sample savings sheet for your members. Please note: this is based on non-network dentists being reimbursed at the Delta Dental Premier maximum plan allowance.
- Checking Status of a Claim
- How to read an Explanation of Benefits (EOB)
- Assignment of Benefits (AOB) Overview
- Coordination of Benefits (COB) Overview
Below are guides to use with your members for standard and non-duplication of benefits coordination of benefits, whichever is applicable to your plan.
- Ortho Payment Policy
- Pre-determination for Your Dental Care Overview
Members are asked to request a predetermination from their dentist when a proposed treatment plan is estimated to cost more than $200. Share this guide to help your members get an idea of how much a dental treatment will cost before they take a seat in the dentist chair.
- Delta Dental PPO and Premier Claim Form
Delta Dental PPO and Delta Dental Premier dentists automatically file claims on members’ behalf. If you visit a non-network dentist, you may have to file your own claim. Download the claim form.
- DeltaVision® Out-of-network Claim Form (if applicable)
Members will only need to complete this form if they are visiting a provider that is not a participating provider in the EyeMed network. Not all DeltaVision plans have out-of-network benefits, so members should consult their benefits information to ensure coverage of services and/or materials from non-participating providers.
- Claims Appeal Summary and Procedures
- Refer a Dentist
Delta Dental of Illinois maintains direct control over network management and owns our dental network. Local staff members foster strong relationships with dentists – and all dentist recruitment is managed locally from our Naperville headquarters. This approach helps maintain network stability.
Members can refer a dentist to join a Delta Dental network using our Network Referral form.
- International Claims
- Understanding Dental Fee Reimbursement Percentiles
90th percentile does not mean 10 percent savings or a 10 percent discount. Actual savings are determined by the fees in the sample and where the fee in question fits within that sample. Read our guide to percentiles.