Canadian Dental Care Plan preauthorization process video: Additional units of scaling

Transcript

Additional units of scaling

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Preauthorization Process: Additional Units of Scaling

[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 and periapical conditions. Not all requests for preauthorization will be approved under the CDCP.

This is why it is important to submit all requested documentation to confirm that the service 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.

When submitting a preauthorization request for additional units of scaling or root planing, providers need to submit the following:

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A completed claim form indicating the procedure codes.

A treatment plan indicating all relevant completed and pending treatment needs or based on the provider's scope of practice, you must have a confirmation that potential basic needs are being referred and/or are being addressed.

We also need dated periapical and bitewing radiographs taken within the last 12 months. If these radiographs cannot be provided, the CDCP will consider preauthorization submission with alternative documentation.

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For oral health providers who are not authorized to prescribe radiographs in their jurisdiction, the CDCP will consider alternative documentation along with a rationale.

We also need a complete dated periodontal chart, including periodontal measurements.

If completion of the periodontal chart is not possible, a justification is required.

And finally, any pertinent clinical findings and notes supporting the request including medical condition relative to periodontal diseases and prescribed medication.

If dated photos are submitted, they will only be used to help validate information provided into the required documentation. A decision cannot be made solely on photos.

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You can find more information in the CDCP Dental Benefits Guide at Canada.ca slash dental.

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Canada.ca/dental

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