Coordination of benefits between the CDCP and Manitoba’s dental program

Program Name

Employment and Income Assistance (EIA) – Dental services

Dental intake line:
204-945-8767

Administrator

Department of Families

Dental intake line:
204-945-8767

What is the payer order between CDCP and Manitoba's dental program?

The CDCP will be the primary payer relative to Manitoba's dental program.

How do providers submit CDCP claims to Sun Life?

Submitting claims under the CDCP will be done in the same way you are doing now with other insurance plans, so the process will be very familiar and easy.

Claims and CDCP client eligibility verification can be submitted through CDAnet, CDHAnet, and DACnet using oral health providers' existing Practice Management Software (PMS).

For more information on the claims submission process for CDCP, please consult the Sun Life claims submission information document.

How will the CDCP and Manitoba coordinate benefits?

COB claim submission process – through EDI:

Where patients are eligible for CDCP and dental benefits under Manitoba's program, providers will need to:

• Indicate in the patient's profile of their PMS that CDCP is the primary payer and Manitoba's program is the secondary payer.
• Submit the claim through EDI:
  • The claim will automatically go to Sun Life first. Sun Life will generate an Explanation of Benefits (EOB) that will show the eligible amount covered under the CDCP (Total Payable to Provider).
  • Make sure to indicate Pay to Provider, Assignment of Benefits, or equivalent (depending on the software) in your PMS - otherwise, your claim submission will be rejected by Sun Life. You will have to choose to assign benefits in your PMS and resubmit your claim.
  • Providers will then need to send the EOB and an accompanying secondary payer claim form to the Manitoba Department of Families, who will process the claim for any remaining charges according to their program policies.
• In cases where Manitoba's program fees are greater than CDCP fee rates, providers will be able to seek additional reimbursement from Manitoba's program up to the Manitoba program fee guide rates, through coordination of benefits.
• Some services covered by the CDCP and by Manitoba's program are subject to frequency limits. These frequency limits are not cumulative - neither the CDCP nor Manitoba's program will provide coverage for services beyond their respective frequency limits.
• Note for restorative treatments: Members of the Manitoba dental program can seek reimbursement from the Manitoba Department of Families for any fees not covered by the CDCP, up to a limit of $600 in any 12 month period.
• Any balance remaining after coordination of benefits through the Manitoba dental program is not to be charged to the clients.
• Clients will only be responsible for paying any applicable co-payment or services that are not covered by the CDCP or Manitoba' dental program.
• Providers must submit the EOB to the Manitoba Department of Families within 14 months, either electronically or by paper in accordance with the existing process for Manitoba's program.

More details concerning updates to the COB process effective November 2024 will be shared in the coming months.

What if services require preauthorization?

CDCP will start accepting requests for preauthorizations effective November 2024. There is no coverage under CDCP for services requiring preauthorization prior to November 2024 and there will be no coordination of benefits.