Information on the CDCP for Oral Health Providers in Alberta

April 2024
Version 1.0

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 CDAnet, CDHAnet, and DACnet 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.

How will the CDCP coverage work in Alberta?

The CDCP will be the only payer where a patient is eligible under the CDCP.

How to submit a CDCP claim as primary payer — through EDI?

• Indicate in the patient's profile of their PMS that the CDCP is the primary payer.
• Submit the claim through EDI:
  • The claim will automatically go to Sun Life first. Sun Life will generate an Explanation of Benefits (EOB) that will show the eligible amount covered under the CDCP (Total Payable to Provider).
  • Make sure to indicate Pay to Provider, Assignment of Benefits, or equivalent (depending on the software) in your PMS — otherwise, your claim submission will be rejected by Sun Life. You will have to choose to assign benefits in your PMS and resubmit your claim.
• 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.

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.