Information on the CDCP for oral health providers in Alberta

November 2024
Version 2.0

How will the CDCP coverage work with Alberta provincial dental programs?

• At this time, coordination of benefits between the CDCP and Alberta provincial dental programs is not being implemented.
• It is the CDCP patient/client's choice whether they wish to access benefits through the province of Alberta's provincial dental programs or the CDCP, and they are encouraged to discuss with their provider the best option for them that limits what they need to pay out of pocket as applicable.

How do providers submit CDCP claims to Sun Life?

• The claim submitted to the CDCP through Sun Life will generate an Explanation of Benefits (EOB) that will show the eligible amount covered under the CDCP (Total Payable to Provider).
• CDCP clients will continue to be responsible for paying, directly to the provider, any applicable co-payment and any remaining amounts not covered by the CDCP, as applicable.

What if services require preauthorization under the CDCP?

• Some services under the CDCP require prior approval through preauthorization before the treatment is confirmed for coverage under the plan. Certain services always require preauthorization, and services above CDCP frequency limitations can also be requested through preauthorization.
• CDCP is accepting preauthorization requests effective November 1, 2024.
• Providers should refer to the CDCP Dental Benefits Guide for services covered by the CDCP and the policies, including criteria, guidelines and limitations, as well as the CDCP Dental Benefit Grids for the list of procedure codes that always require preauthorization - under "Schedule B" or identified with a "P". This also includes treatment for services available without prior approval, but that would be above established frequency limits.
• Oral health providers need to submit all required and relevant documentation available to support the request directly to Sun Life. Please refer to the CDCP Dental Benefits Guide for documentation requirements.
• If a service requires preauthorization under the CDCP, the preauthorization request for that service must always be submitted to the CDCP, regardless of whether the service is covered or has been preauthorized by another federal or provincial dental program.

Resource:

For more guidance on the claims submission process for CDCP, including preauthorization, post-determination, and reconsideration steps, please refer to the Sun Life claims submission information resource.