Coordination of benefits between the CDCP and the Yukon’s territorial dental programs

November 2024
Version 2.0

Program Name	Contact Information
Yukon Dental Program (YDP)	Yukon Dental Program Phone: 867-667-5209 Email: dentalprogram@yukon.ca
Extended Health Care Benefits for Seniors	Extended Health Care Benefits for Seniors: Phone: 867-667-5403 Toll free: 1-800-661-0408
Yukon Children’s Dental Program	General Inquiries: Phone: 867-667-8360 Toll free: 1-800-661-0408 extension 8360 Email: dentalhealth@yukon.ca

Third-Party Administrator	Contact Information
Pacific Blue Cross (PBC) (for YDP and the Extended Health Care Benefits for Seniors' programs)	Toll free: 1-877-722-2583 Fax: 604-419-2990 Mailing Address Pacific Blue Cross PO Box 7000 Vancouver, BC V6B 4E1

What is the payer order between the CDCP and the Yukon's dental programs?

• The CDCP will be the primary payer relative to all of the Yukon's dental programs.
• Yukon will be the secondary payer.

  Depending on a client's benefit access, the payer order may look as follows:

  • CDCP first, Yukon Dental Program second, Extended Health Care Benefits third (if applicable)
  • CDCP first, Yukon Children's Dental Program second

How will the CDCP and the Yukon 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 any potential secondary payer, according to their usual process and the secondary payer will process the claim according to their program policies (details are listed below):
  • For the Yukon Dental Program and Extended Health Care Benefits Program:
    • The EOB should be sent to the Yukon’s third-party administrator (Pacific Blue Cross). If any charges remain, Pacific Blue Cross will process the claim according to the Yukon’s program policies.
    • The EOB from Sun Life must be submitted to Pacific Blue Cross within 12 months of the date the service has been rendered, either electronically or by paper in accordance with the existing process for the relevant Yukon program.
  • For the Yukon Children’s Dental Program:
    • Providers will need to attach the EOB to the Dentist Monthly Account and submit it to the Yukon Children’s Dental Program as per the existing process.
    • For the Yukon Children’s Dental Program, all claims must be submitted to the Yukon Department of Health and Social Services by March 31, the Government of Yukon’s fiscal year end.
• In cases where the Yukon’s program fees are greater than the CDCP’s fees, providers will be able to seek additional reimbursement from the Yukon’s programs up to the Yukon’s program fee guide rates, through coordination of benefits, up to any program annual limits. 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 the Yukon’s dental programs are subject to frequency limits which may differ with respect to dollar value or timeframe. These frequency limits are not cumulative — neither the CDCP nor Yukon’s programs will provide coverage for services beyond their respective frequency limits.
  • The Yukon Children’s Dental Program covers one dental exam per referral. For any additional services, frequency limits will be considered in accordance with the Yukon Children’s Dental Program referral guidelines.
• 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 and/or the Yukon’s territorial dental programs, and that may be beyond the respective Yukon program’s annual spending limits.

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?

For the Yukon Dental Program, please note the following:

• The Yukon Dental Program will not cover retroactive claims for services provided before the date of the member's enrollment in the Yukon Dental Program.
• The Yukon Dental Program will cover co-payment portions for beneficiaries provided the amount is within the $1300 annual limit for eligible services.

For the Yukon Children’s Dental Program, please note the following:

• While the CDCP is the primary payer, coverage under the Yukon Children’s Dental Program still requires that a child be enrolled under the program and that a referral for services be provided by the Yukon Children’s Dental Program. Coverage is limited to those services listed on the referral or preauthorized by the Yukon Children’s Dental Program.
• The referral provided by the Yukon Children’s Dental Program is only available to access services within the Yukon. The Yukon Children’s Dental Program does not cover the cost of any dental services provided outside of the Yukon.

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.