Fact sheet – Educational Institution CDCP Participation Guide

Useful information to help you navigate and understand the participation process as an educational institution clinic under the CDCP.

Educational institution clinics are key partners in the CDCP servicing a large portion of the CDCP member demographic while educating future Canadian oral health professionals for all Canadian residents.

The following information may be helpful in preparing to participate in the CDCP as an educational institution clinic.

How to Participate

• Educational institution clinics (schools) can confirm their participation in the CDCP by completing the Claims Processing and Payment Agreement for Educational Institution Clinics.
• Schools will need to complete the agreement on paper and send it to Sun Life for processing.
• To complete the form, you'll need an institutional Unique Identifier Number (UIN) for your clinics. These can be provided to you by your professional association:
  • Canadian Dental Association (CDA),
  • Denturist Association of Canada (DAC),
  • Canadian Dental Hygienists Association (CDHA) or
  • Association des chirurgiens dentistes du Québec (ACDQ).
• Some schools may have multiple UINs for the variety of clinics for oral health professions or specialties that they offer. Schools may include as many clinic UINs as needed in their participation agreement.
• Once your participation is confirmed, Sun Life will help you set up your Sun Life Direct account. There you'll be able to confirm client eligibility, co-payment levels and frequency limits and review explanation of benefits as well as preauthorization decisions (preauthorizations start in November 2024).

Who can complete the Claims Processing and Participation Agreement for educational institution clinics?

The agreement must be completed by an individual authorized to:

• Legally commit your educational institution clinic(s) to the terms of the agreement, acting on behalf of the supervising oral health professionals for which students deliver care to patients in the clinics of that institution.
• Invoke the UIN(s) of your educational institution to attest to matters such as financial/billing related activities.
• Confirm which services (by using specific procedure codes) have been provided to patients of the educational institution.
• Provide access to the educational institution clinic’s information required for claims verification.

How to confirm patient coverage

• When recommending treatment to a patient, you can confirm their coverage by:
  • Checking Sun Life Direct’s coverage look-up tool, by
  • Calling Sun Life’s CDCP contact centre or
  • Submitting an Electronic Data Interchange (EDI) estimate.
• Updates to the coverage look-up tool’s procedure code list are being made and some of the procedures may not display. You can still submit an estimate or call the contact centre to confirm coverage.
• Services requiring preauthorization won’t be covered under the CDCP until November 2024. Consult the CDCP dental benefit grids on the Sun Life Public Website and the CDCP dental benefits guide on the Government of Canada’s CDCP website for more details.
• Let your patient know if they’re required to pay any out-of-pocket amount before their treatment. This amount could include their co-pay requirements, additional fees, or charges that aren’t covered by the CDCP.

How to submit claims

• Your school must be participating in the CDCP to submit claims to the CDCP. CDCP will not accept claims submitted directly by CDCP members.
• Claims for eligible services must be submitted directly to the CDCP for payment to Sun Life, within one (1) year of the service date.
• EDI claims submission is the exclusive method accepted during the first six (6) months of the Plan (May 1 to October 31, 2024).
• To submit claims through EDI, you’ll need a Unique Identifier Number (UIN) and EDI submission software.
• You can submit EDI claims to the CDCP through your patient management software (PMS) in the same way you submit claims for other insurance plans.
• Paper claims will be accepted starting in November 2024.
• You may choose to hold your paper claims for services provided between May 1 and October 31, 2024, to submit in November 2024.
  • Note, that if your CDCP client/patient subsequently seeks the same service at a clinic who submits EDI before November, your claim for that patient’s treatment could be denied.
• Coordination of benefits is only allowed with provincial/territorial or federal dental plans. More information will be provided to allow enough time to familiarize yourself before launching claims processing.

Receiving payments and statements

• You can receive payments through Electronic Fund Transfers (EFT) or by cheque.
• You will be paid within 48 hours by EFT and will receive notification that your claim statements are in your Sun Life Direct account.
• If you’re paid by cheque, you’ll receive payments and accompanying statements monthly.
• To provide banking information for EFT, you’ll need to download the direct deposit form from the Sun Life website.