Since December 2023, the Canadian Dental Care Plan (CDCP) has been implemented slowly, in various stages. As a dental care provider, you may have some questions regarding this new program. This guide will answer some of them for you.

What is the CDCP?

The CDCP is a federal government program carried out by Sun Life, that aims to minimize oral health care costs. It was established by the Canadian government, in order to assist Canadian residents who do not have oral health care benefits or a household income of up to $90,000, to be able to still receive dental care.[1]

What does the CDCP mean for your dental practice?

For dental care providers to participate in the CDCP they need to confirm their participation with Sun Life via a Sun Life Direct account which they have created or by calling Sun Life.[2] By agreeing to participate, providers accept to receive and will receive direct payment from Sun Life whether by monthly cheque or EFT, reducing costs to the patient, making oral health care more accessible.[3]  However, as of July 8, 2024, providers will be able to participate in the CDCP and direct bill Sun Life for dental services completed on a claim-by-claim basis without having to register for the CDCP. [4] Resultantly, CDCP patients will be able to go to any oral health care provider, being that the provider accepts to direct bill Sun Life.[5]

According to the Government of Canada, providers need to complete the following 3 actions before providing care to CDCP patients[6]:

1. Confirm patient eligibility for the Canadian Dental Care Plan

• Verify the patient’s identity
• Ask for the patient’s CDCP member card – this will have their member ID number
• Ensure patient’s CDCP coverage has started, which is stated in their Membership package

2. Confirm the patient is covered for certain services

• Use your dental practice management software to send predetermination via EDI
• Use Sun Life Direct search to validate a patient’s eligibility for services and frequency limits
• Call the CDCP contact center to confirm a patient’s eligibility

3. Submit a claim with benefits assigned

• Use your dental practice management software to submit claims electronically via EDI

Moreover, even though the CDCP is in effect, for many patients, their dental care will not be fully covered. Depending on the patient’s income, they may have to pay a portion of the treatment cost (ie: co-payment), which should be taken into consideration when charging CDCP patients[7]:

• For patients who have an income between $80,000 to $89,999 their co-payment will be 60% of the cost of CDCP eligible treatment (40% covered by the CDCP)
• For patients who have an income between $70,000 to $79,999 their co-payment will be 40% of the cost of CDCP eligible treatment (60% covered by the CDCP)
• For patients who have an income less than $70,000 they will have no co-payment (100% of the cost of CDCP eligible treatment covered by the CDCP)

How can your dental practice management software help you integrate the CDCP into your dental office?

Electronic Claim Submission

CDCP claims can only be submitted electronically via EDI to Sun Life (until November 2024)[8]. Therefore, in order to participate and be a CDCP provider, you must ensure your dental practice management software is configured for electronic claim submission and that you utilize this feature for claim submission.

Coordination of Benefits (COB)

With the CDCP, coordination of benefits with other insurance plans might be possible. Your dental software solution should have electronic claim submission set-up and this feature must be adopted in your dental practice, especially for CDCP patients. Additionally, your dental practice management solution, within the insurance section of the patients file, should have the capability to store both government dental programs so that COB can be carried out. The CDCP should be marked as the primary payer, and the other dental program(s) should be marked as the secondary payer.

Fee guide

The CDCP has its own fee guide/schedule. Check with your practice management software that they have implemented this fee guide into your system, or that they can if they haven’t yet. This ensures that treatment planning, billing and claim submission for CDCP patients is streamlined, making the integration process seamless.

Frequency limits and coverage

For some dental services within the CDCP there are frequency limits for the year. Utilize your dental software to note what CDCP patients are covered for (ie: limits and coverage). If your dental practice software has an alerts and notes feature, create a note and set an alert for that note, so that every time a CDCP’s patient file is opened and you are booking an appointment, you see that note and their coverage details. This warrants that less time will be spent booking patient appointments as you’re not left wondering whether a service will be covered or not. Moreover, use treatment plans and codes, as well as patients’ past appointments to quickly determine what has been used up considering frequency limits and/or coverage limits for CDCP patients.

ADSTRA’s dental office software contains all of the features and capabilities mentioned above, making the solution fully prepared for dental care providers to become part of the Canadian Dental Care Plan and to accept CDCP patients.

If you’re looking to become a CDCP provider and need a dental software for claim submission, or you’re an existing user that needs some assistance preparing your office to become participants of the CDCP, contact us! 

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[1] Canadian Dental Association: About the CDCP – https://www.cda-adc.ca/en/oral_health/cdcp/

[2] Sun Life – Oral Health Provider: How to participate in the CDCP – https://www.sunlife.ca/sl/cdcp/en/provider/

[3] Government of Canada: Participation in the CDCP – https://www.canada.ca/en/services/benefits/dental/dental-care-plan/providers.html#h2.1 AND Sun Life CDCP PDF: Receive Payments – https://www.sunlife.ca/content/dam/sunlife/regional/canada/documents/cxo/cdcp/cdcp-csi-en.pdf

[4] Government of Canada: Providing services on a claim-by-claim basis – https://www.canada.ca/en/services/benefits/dental/dental-care-plan/providers.html#h2.1

[5] Government of Canada: Providing services on a claim-by-claim basis – https://www.canada.ca/en/services/benefits/dental/dental-care-plan/providers.html#h2.1

[6] Including list of actions – Government of Canada: Providing services on a claim-by-claim basis – https://www.canada.ca/en/services/benefits/dental/dental-care-plan/providers.html#h2.1 AND Sun Life CDCP pdf – https://www.sunlife.ca/content/dam/sunlife/regional/canada/documents/cxo/cdcp/cdcp-csi-en.pdf

[7] Including co-payment schedule – Canadian Dental Association: Know Before You Go – https://www.cda-adc.ca/en/oral_health/cdcp/

[8] Sun Life CDCP PDF: Submit a claim – https://www.sunlife.ca/content/dam/sunlife/regional/canada/documents/cxo/cdcp/cdcp-csi-en.pdf