Coordination of benefits between the CDCP and Manitoba’s provincial dental program
November 2024
Version 2.0
This fact sheet is intended to provide information on the approach to coordination of benefits between the Canadian Dental Care Plan (CDCP) and Manitoba's provincial dental program, as noted below.
Note: Individuals with private insurance are not eligible for the CDCP, and therefore there would be no coordination of benefits with the CDCP. Should clients have dental benefits through a private plan, then providers must not submit claims to the CDCP.
| Program Name | Contact Information |
|---|---|
| Dental Services for the Employment and Income Assistance Program (EIA) / Manitoba Supports for Persons with Disabilities (MSPD) | Dental intake line: |
| Administrator | Contact Information |
|---|---|
| Department of Families | Dental intake line: |
What is the payer order between the CDCP and Manitoba's provincial dental program?
- The CDCP will be the primary payer relative to Manitoba's provincial dental program.
- Manitoba will be the secondary payer.
How will the CDCP and Manitoba coordinate benefits?
- The claim should be submitted to the CDCP first, through Sun Life. Sun Life will generate an Explanation of Benefits (EOB) that will show the eligible amount covered under the CDCP (Total Payable to Provider).
- Providers will then need to submit the claim to the Manitoba Department of Families as secondary payer within 14 months of the date the service has been rendered for any remaining amounts. The EOB and accompanying secondary payer claim must be mailed to Dental Services, Manitoba Department of Families, 100-114 Garry Street, Winnipeg, R3C 4V4, who will process the claim for any remaining charges according to their program policies.
- In cases where Manitoba's program fees are greater than the CDCP's fees, providers will be able to seek additional reimbursement from Manitoba's program up to Manitoba's program fee guide rates, through coordination of benefits. In cases where program fees are equal to or lower than CDCP fees, there will be no additional reimbursement on fees.
- 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: providers 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.
- 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.
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.
What else do providers need to know?
When a preauthorization is required for the CDCP, Dental Services for the EIA and the MSPD may require a prior approval as well. It is important to note which services require prior approval and to ensure all the required preauthorization had been obtained prior to beginning this treatment. Dental Services for the EIA and the MSPD lists a series of services requiring prior approval. Some dental procedures and services not listed may be considered under extraordinary circumstances subject to approval by the Manitoba Minister or Minister's designate. Additional information is provided in Schedule B of the Department of Families Health Service Dental Program - Schedule of Fees and Services (sent to registered providers).
Resource:
For more guidance on the claims submission process for CDCP, including preauthorization, post-determination, and reconsideration steps, please refer to the claims submission information resource.