Coordination of benefits between the CDCP and Quebec’s provincial dental programs

November 2024
Version 2.0

How will the CDCP and Quebec coordinate benefits?

• At this time, services covered by Quebec dental programs including 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 Quebec dental programs.

Program Name	Billing Procedure
RAMQ – Children under 10	Providers need to bill RAMQ for services covered under RAMQ. The CDCP will not provide coverage, reimbursement or coordinate benefits for these services, 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 as long as the client is eligible for coverage under the CDCP on the date of service.
RAMQ – recipients of a financial assistance program with claim slip and their dependants	Providers need to bill RAMQ for services covered under RAMQ. The CDCP will not provide coverage, reimbursement or coordinate benefits for these services, 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 as long as the client is eligible for coverage under the CDCP on the date of service.
Other programs funded by the "Ministère de la Santé et des Services sociaux"	Providers 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, as long as the client is eligible for coverage under the CDCP on the date of service. For more information on programs offered by the “Ministère de la Santé et des Services sociaux”, please see: https://www.msss.gouv.qc.ca/professionnels/sante-dentaire/activites-et-services-sante-dentaire/ (French only), and https://www.msss.gouv.qc.ca/professionnels/sante-dentaire/services-offerts-sante-dentaire-clinique/ (French only).

• CDCP clients will continue to be responsible for paying, directly to the provider, any applicable co-payment and any amounts not covered by the CDCP or Quebec dental programs.

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