Canadian Dental Care Plan preauthorization process video: Partial dentures

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Partial dentures

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Canadian Dental Care Plan Preauthorization Process: Partial Dentures

[English audio]

Health Canada employee

The Canadian Dental Care Plan - or - the CDCP's preauthorization process differs from private insurance plans and the coverage criteria are more stringent with a focus on the management of basic treatment for caries, periodontal disease or periapical conditions. Not all requests for preauthorization will be approved under the CDCP.

This is why it's important to submit all requested documentation to confirm that the services will be covered under the CDCP before the treatment is done. If you submit your request and supporting documentation by Electronic Data Interchange or EDI, you need to make sure that your practice management software supports the submission of attachments through EDI. If this is not the case, please submit your preauthorization request and all supporting documentation by mail only.

This video focuses on the details and documentation needed when submitting a preauthorization request for removable partial dentures.

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One of the criteria that providers may not be used to is that there must be one or more missing teeth in the anterior sextant or there must be two or more posterior teeth in a quadrant excluding the second and the third molars. That is why providers need to submit the following:

• a completed claim form indicating the procedure code for the partial denture;
• a treatment plan indicating all relevant completed and pending treatment needs;
• or, based on the provider's scope of practice, confirmation that potential basic needs are being referred or are addressed.

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Dated periapical radiographs of abutment teeth and dated bitewing radiographs taken within the last 12 months.

If radiographs are not available, we need one of the following:

2 dated photos of stone models including a separate upper, and a lower, or 2 dated photos of the maxillary and mandibular arches; or dated stone models of the upper and lower arch.

We also need a notation of all missing teeth or the most recent panoramic radiographs; and finally a notation of any planned extractions before the partial denture placement.

It is important to note that complete and partial dentures supported by implants as well as all implant-related procedures are not covered under the CDCP.

You can find more information in the CDCP Dental Benefits Guide at:

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