Coordination of benefits between the CDCP and Quebec’s dental programs
April 2024
Version 1.0
This fact sheet is intended to provide information on the coordination of benefits between the Canadian Dental Care Plan (CDCP) and Quebec's dental programs 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.
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 Réseau ACDQ, DACnet, CDHAnet and CDAnet 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.
Please note that before November 2024, the CDCP will only accept electronic claims submission through Electronic Data Interchange (EDI). If a provider does not have EDI capability, they will be unable to seek reimbursement from Sun Life until November 2024.
How will the CDCP and Quebec coordinate benefits?
- At this time, services covered by Quebec dental programs under the Régie de l'assurance-maladie du Québec (RAMQ) will not be reimbursed by the CDCP. Quebec will be the only payer for services covered by RAMQ.
| Program Name | Billing Procedure |
|---|---|
|
RAMQ – Children under 10 |
Providers will need to bill RAMQ for services covered under RAMQ. The CDCP will not provide coverage or coordinate benefits for these services. These services will not be reimbursed by the CDCP, even if submitted by providers not participating in RAMQ. Where services are not covered by RAMQ and are eligible for coverage under the CDCP, claims for these services can be submitted to Sun Life and will be paid if the service is done after the CDCP coverage start date of the CDCP client. Only electronic claims will be processed prior to November 2024. |
|
RAMQ – recipients of a financial assistance program with claim slip and their dependants |
Providers will need to bill RAMQ for services covered under RAMQ. The CDCP will not provide coverage or coordinate benefits for these services. Where services are not covered by RAMQ and are eligible for coverage under the CDCP, claims for these services can be submitted to Sun Life and will be paid if the service is done after the CDCP coverage start date of the CDCP client. Only electronic claims will be processed prior to November 2024. |
|
Other programs funded by the "Ministère de la Santé et des Services sociaux" |
Providers will need to bill the appropriate Quebec dental program first for reimbursement for services covered under that program. If the services are provided on a fee for service basis, are not covered by the Quebec dental program, and are eligible for coverage under the CDCP, then claims for these services can be submitted to Sun Life. The claims will be paid if the service is done after the CDCP coverage start date of the CDCP client. Only electronic claims will be processed prior to November 2024. For more information on programs offered by the "Ministère de la Santé et des Services sociaux", please see: Activités et services offerts en santé dentaire publique (French only), and Services offerts en santé dentaire clinique (French only). |
- CDCP clients will continue to be responsible for paying, directly to the provider, any amounts not covered by the CDCP (including any applicable co-payment) or Quebec dental programs.
- Clients are also responsible for paying, directly to the provider, any additional amounts billed by the provider.
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.
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