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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
This Act may be cited as the
Uniform Electronic Transactions in Dental Care Billing Act.
The purpose of this Act is to
standardize the forms used in the billing and reimbursement of
dental care, reduce the number of forms used, increase
efficiency in the reimbursement of dental care through
standardization, and encourage the use of and prescribe a
timetable for implementation of electronic data interchange of
dental care expenses and reimbursement.
Except as may be otherwise
specifically provided, this Act applies to all dental plan
As used in this Act:
"Department" means the Department of Insurance.
"Director" means the Director of Insurance.
"Dental care provider" means a dentist who bills for
services in Illinois.
"Dental plan carrier" means an entity subject to the
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insurance laws and regulations of this State or subject to the
jurisdiction of the Director that contracts or offers to
contract to provide, deliver, arrange for, pay for, or
reimburse any of the costs of dental care services, including
an accident and health insurance company, a health maintenance
organization, a limited health service organization, a dental
service plan corporation, a health services plan corporation,
a voluntary health services plan, or any other entity
providing a plan of dental insurance, dental benefits, or
dental health care services.
Uniform electronic claims and eligibility
(a) Beginning January 1, 2025, no dental plan carrier is
required to accept from a dental care provider eligibility for
a dental plan transaction or dental care claims or equivalent
encounter information transaction except as provided in this
(b) All dental plan carriers and dental care providers
must exchange claims and eligibility information
electronically using the standard electronic data interchange
transactions for claims submissions, payments, and
verification of benefits required under the Health Insurance
Portability and Accountability Act in order to be compensable
by the dental plan carrier.
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Rules; modification of rules.
(a) The Department shall adopt rules as necessary to
implement this Act and may establish exemptions to this Act by
(b) A dental plan carrier or dental care provider may not
add to or modify the uniform electronic claims and eligibility
requirements adopted by the Department.
This Act takes effect upon