ok in the right Margin of this webpage under Treatment Plan Examples. Click the example 3 for a good CDCP template example.

Want to confirm your attachments were successfully sent? WATCH THIS VIDEO!!  Look for the green checkmarks! If you see them, it means Sun Life has received your attachments.

Keep in mind that Sun Life operates two database systems, and their phone support staff don’t have access to the live system. They are, however, having an issue their systems. We are continuing to provide feedback and expertise to Sun Life. That’s why using DOMx makes all the difference—it’s one of the very few software programs that flawlessly handles attachments. 

Dec 17th: The following is the official communication from Sun Life on the issue of their errant response NXD: This submission was received without any supporting documentation.” 

—

“Hi Dean, Since you identified the gap, Sun Life implemented an interim process which is in place and will ensure that Sun Life can view the attachments sent by oral health providers. If providers are still experiencing trouble please direct them to the Sun Life dedicated call centre for assistance.

.. This is 100% a gap at Sunlife and I apologize that you are having to deal with it…

Thanks again and always your collaboration is truly appreciated.”

—

If you call the support line about this issue and they don’t give any acknowledgment that it will be looked at and fixed. Please ask for the Sun Life support reps identification and note the time of the call and email the details to admin@specializedoffice.com subject “Attn Dean NXD” 

 Dec 16th: Sun Life techies have informed us that they have enough examples of responses that have come back errantly of ““NXD: This submission was received without any supporting documentation.” They have made this a number 1 priority to fix. We expect more information from them soon. 

Government of Canada CDCP video tutorial – released Dec 12, 2024 click to watch

Government of Canada CDCP check list as up Dec 16, 2024 click to download

DAC Dec 16 CDCP Update notice

Dec 11th UPDATE: Important Update Regarding Sun Life Responses

We’ve noticed an increase today in Sun Life responding with:
“NXD: This submission was received without any supporting documentation.”

If you’ve received this response, please follow these steps in your DOMx account to verify your submission:

1. Go to your account history.
2. Select the pre-authorization in question.
3. Press Edit and navigate to the Attachments tab.
4. Check for green checkmarks beside each of your attachments.

If you see green checkmarks, rest assured that DOMx successfully sent the attachments. Sun Life is aware of this issue they are having and working to resolve it on their end

We’re actively following up with Sun Life to understand why this response is being sent today. I will post updates here as soon as we have more information.

Dec 3rd UPDATE: We had a productive meeting with Sun Life Claims Management on Monday Dec 1. They are aware of a lot of the miscommunication coming from their phone support staff and aware of some further education to their adjudicators who have sometimes been misconstruing regular block business with CDCP business.  They have released the following statement.

 “The preauthorization process is not to determine if the provider’s proposed treatment is the right treatment — that decision is between the provider and their patient. Instead, this process confirms if the proposed treatment or service meets the CDCP coverage criteria and will be covered by the plan. (click to read full statement)“

 To that goal you can focus your submissions to prove the following highlights of the CDCP Dental Benefits Guide (click here to see the whole guide)

6.5.2.3 Eligibility

The CDCP will consider coverage for a partial denture for teeth numbered 16 to 26 and 36 to 46 inclusive, under the following conditions:

• general conditions:
• all basic treatment must be completed including:
• control of caries and of periodontal and periapical disease for all teeth, and
• restoration of major structural defects in the abutment teeth
• the space to be replaced is greater than or equal to the corresponding natural teeth (vertically and horizontally)
• if there is an existing partial cast denture paid for by the CDCP, it must be at least 96 months (8 years) old
• if there is an existing partial acrylic denture paid for by the CDCP, it must be at least 60 months (5 years) old
• specific conditions:
• there must be 1 or more missing teeth in the anterior sextant, or
• there must be 2 or more missing posterior teeth in a quadrant excluding second and third molars

6.5.2.4 Preauthorization documentation requirements for partial dentures

• Treatment plan
• 1 of the following:
• periapical radiographs of abutment teeth and bitewing radiographs (within last 12 months); or
• when it is not possible to obtain periapical or bitewing radiographs, the most recent panoramic radiograph; or
• if radiographs are not available, 1 of the following:
• photos of stone models (3) (upper and lower separate, and in occlusion); or
• photos of the maxillary and mandibular arches (3) (maxillary and mandibular arches separate, and in occlusion); or
• stone models (upper and lower)
• As of Dec 16, 2024 The DAC has successfully advocated for the removal of the requirement for “in occlusion” photos or models under the CDCP. These are no longer needed. so just 2 photos: Upper and Lower
• Notation of all missing teeth and/or panoramic radiograph
• If extractions are planned, notation of planned extractions prior to denture placement

——– Tips ——-  

Government of Canada CDCP check list as up Dec 16, 2024 click to download

Each of the following points are especially important for approval. 

 Consultation and general oral exam completed by denturist xx. (be specific on the type of exam you completed “general” or “emergency” etc)

 All findings for patient are within normal limits for the fabrication of xxx (specify immediate or transitional etc)

 This treatment is not the result of an accident.

 *** Patient’s dentist, (Dr. x if known), confirmed no outstanding dental treatment required including controlled caries and of periodontal and periapical disease for all teeth.

All abutment teeth have no need for restoration of major structural defects. (if partial) 

 (List the missing teeth in the treatment plan or tooth chart. They want a visual and text with the dates the teeth were extracted. If they were extracted recently find out the exact date. If they have been missing for years you can give an estimation based on patient interview and clinical findings.)

Existing missing teeth:  list each one and estimated date(s)

Recently extracted teeth: list each one and date(s) of extraction

Planned extractions: list each one and possible future dates for extraction

— —-Attachments ——

1) Treatment plan with text above

2) dentition aka tooth chart

3) panoramic x-ray  OR  2 pics of 1) upper; 2) lower  (can be stone models or patient’s actual mouth w cell phone emailed to yourself in lower size and attached)

CDCP is also claiming they want the patient’s name and date the pic was taken on the pic itself. You can attach the image in DOMx clinical tab then double click it or press edit and DOMx has a patient name and date stamp now since version 14.7.2.41 Microsoft Paint to add this text to the picture itself. We are working on some functionality that could do this for you

——– Sunlife Responses ——

Sunlife is going to work on much more specific responses but the moment you are probably seeing one of two responses:

Request for Addition information: As of Dec 3^rd 2024 these responses are not very specific and essentially list everything you should submit, not necessarily what is missing. You will need to review what you sent to the criteria above to figure that out. At this point calling Sun Life Support is not always helpful so far. On the contrary, in many cases these staff members have been misconstruing CDCP requirements with other blocks of business for private plans. Sunlife management is aware and working on education and improvements. We advise that you carefully review the information above and decide what is needed.  

With DOMx you can simply add more attachments to the existing pre-auth. Go to Account History; select the pre-auth; press the edit button; go to the Attachments tab. You will see all the attachments that have already been sent with nice green check marks. If one is missing green check mark it was not successfully sent yet. It could be it failed to send because it made the first submission over 7MB in file size total. If that’s they case, you can simply press the Send button at the far right to try and sent it again or attach a new smaller version of that file. To add new attachments simply use the attachment buttons then press the send button at the far right.

Denial of Service as it did not meet the plans criteria for coverage: This response means they have received all the relevant info and attachments and have denied. They do not, as of yet, tell you why.  

If your case has been denied. And you feel you have a good clinical response to the following points:

• control of caries and of periodontal and periapical disease for all teeth, and
• restoration of major structural defects in the abutment teeth
• the space to be replaced is greater than or equal to the corresponding natural teeth (vertically and horizontally)

We recommend you take your time and make a brand new pre-auth. While you could add documents and responses to the same pre-auth we recommend you do a brand new one because it will get to a different adjudicator. This new adjudicator will see your previous pre-auth as well so it’s not like they won’t see the prior one! However, you can acknowledge the first pre-auth failure right off the bat in your new treatment plan and explain why it may have failed and how now you are including a written statement from a dentist as to the plan for the dental issues and how this plan addresses all the CDCP requirements. We recommend you copy and quote the relevant sections of the CDCP Dental Benefits Guide see section 6.5.2.3

It is important to note that once a pre-auth has been denied you only get one more chance for this patient so it would behoove you and the patient to get a dentist involved to support the plan in writing. (this is Dean Fenwick’s opinion and not coming from DAC or Sunlife or CDCP this is just my advice on what I’d recommend since after a second denial they will not even look at the case again)