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

April 2024
Version 1.0

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

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

*Applies only to services provided in a private clinic - requires preauthorization and referral by the Yukon Children's Dental Program.

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 and the Yukon coordinate benefits?

Information on coordination of benefits with CDCP and the Yukon Children's Dental Program will be provided by the Yukon's department of Health and Social Services to providers at a future date.

COB claims submission process — through EDI:

Where patients are eligible for the CDCP and dental benefits under a Yukon program, providers will need to:

• Indicate in the patient's profile of their PMS that the CDCP is the primary payer and the Yukon's program is the secondary 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.
  • The Yukon Dental Program: If the provider's PMS is set up to automatically submit COB to the secondary payer, the PMS will then send the EOB 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.
  • Extended Health Benefits Program: Providers will need to send the EOB and an accompanying secondary payer claim form to the Yukon Department of Health and Social Services, who will process the claim for any remaining charges according to their program policies and legislation.
  • The EOB from Sun Life must be submitted to Pacific Blue Cross (Yukon Dental Program) or the Yukon Department of Health and Social Services (Extended Health Benefits Program) 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.
• In cases where the Yukon's program fee rates are greater than CDCP fee rates, 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.
• 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 the Yukon programs will provide coverage for services beyond their respective frequency limits.
• CDCP clients will continue to be responsible for paying, directly to the provider, any remaining applicable co-payment and other amounts not covered by the CDCP and/or the Yukon Dental Program and Extended Health Care Benefits program and that may be beyond the respective Yukon program's annual spending limits.

More details concerning updates to the COB process effective November 2024 will be shared in the coming months.

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 and there will be no coordination of benefits.

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.
• Yukon Dental Program members eligible for CDCP will be required to sign up for CDCP.