The Canadian Dental Care Plan is administered by Sun Life on behalf of the Government of Canada.
For more information about the CDCP, visit the Government of Canada Opens external website in a new windowwebsite.
Transcript
[This message was created jointly with the Government of Canada]
Visiting an oral health provider is important for overall health. A third of Canadian residents don’t have dental insurance, and one in four Canadian residents haven’t seen an oral health provider, because they can’t afford to pay for it.
Last December, the Government of Canada launched the Canadian Dental Care Plan (or CDCP). The CDCP will help make oral health care more affordable for up to 9-million eligible Canadian residents.
Eligible Canadian residents are invited by the Government of Canada to apply. After successfully completing the application process, Sun Life issues a welcome package. These Canadian residents are now CDCP members.
CDCP members can find a participating oral health provider by using the CDCP Provider Search tool on sunlife dot c a forward slash CDCP or by calling their local oral health provider to inquire if they are participating in the CDCP.
We know many of you have questions about this new plan and we’re here to help. We’ve made it easy to submit claims and receive accurate and fast reimbursement.
We’ll show you how.
Use your existing intake process when a CDCP member arrives for their appointment.
You’ll validate the CDCP member’s identity and confirm their coverage information. If the patient has private coverage, they aren’t eligible for coverage under the CDCP.
Confirming coverage for a CDCP member will be familiar to you.
Simply submit an Electronic Data Interchange (or EDI) estimate and the Predetermination Explanation of Benefits will provide details on the member’s coverage.
You can also use Sun Life Direct’s coverage look-up tool, or call Sun Life’s dedicated CDCP contact centre at 1-888-888-8110 to confirm the member’s coverage.
You’ll need to discuss payment, including any possible additional charges with the member before providing care. These additional charges could include their co-pay requirements or amounts and services that aren’t covered by the CDCP.
[ZOOM in on total provider charges and total benefit in EOB and do math to show member paid portion is $100.00-$69.00 = $31.00]
After providing care, you’ll submit the claim through your existing EDI software.
You simply need to enter member and plan data as well as the applicable procedure codes and confirm that the payment must be assigned to the provider, which is often labeled “Take Assignment”. Use the name that is shown on the member’s CDCP member card and ensure you have the correct date of birth on file.
To limit the out-of-pocket costs for CDCP members, you’re required to submit the claim on behalf of the member and accept direct payment from Sun Life. There won’t be a way for CDCP members to receive reimbursement from Sun Life and the member must not be asked to pay upfront for the CDCP covered portion of the claim.
You or your staff don’t need to make any calculations related to the costs that will or will not be covered under the CDCP. You’ll submit the amount you bill. Sun Life will adjudicate the claim and provide an Explanation of Benefits that will indicate the total amount payable to you by the CDCP. The member will pay you any outstanding amount not covered by the CDCP directly, if applicable.
[Zoom in on EOB for the TOTAL PAYABLE TO PROVIDER portion ($12)]
Before July 8, 2024, you must be a participating CDCP provider to submit claims and receive payment under the CDCP.
As of July 8, 2024, oral health providers will be able to direct bill Sun Life for services provided on a claim-by-claim basis without formally signing up for the CDCP.
Paper claims will be accepted from providers starting in November 2024.
For most provincial and territorial public dental programs, the CDCP will be the primary payer.
To help you and your office staff know how to coordinate across various plans in your region, more details on the coordination of benefits are available on Canada dot c a slash dental under the provider section.
If you do business with Sun Life today, you’ll receive payment from Sun Life in the same way, either through direct deposit or by cheque.
CDCP claim payments received by direct deposit will initially take up to 48-hours to be processed, before shifting to a 24-hour turnaround time. Cheques will be mailed monthly.
If you don’t do business with Sun Life today, you’re able to sign up for Electronic Funds Transfer on Sun Life Direct to receive claim payments by direct deposit. Otherwise, you’ll receive claim payments by cheque.
You can find your payment statements for CDCP claims within the Sun Life Direct portal. If you receive claim payments by cheque, the payment statement will be included with the cheque.
Lastly, if you are not a participating CDCP provider and want to participate, log into your Sun Life Direct account and follow the participation steps online or visit sunlife dot c a forward slash CDCP to download the paper form.
Your participation in this plan will make a difference in the lives of so many people. And for that, we thank you!
[This message was created jointly with the Government of Canada]