As reviews mount over excessive rejection charges and paperwork delays within the federal Canadian Dental Care Plan (CDCP), Well being Canada says it’s working to enhance processing instances and help dentists.
On July 6, Canadian Affairs reported that Lindy Vanamburg, director common of the Oral Well being Department at Well being Canada, mentioned 49 per cent of claims for complicated dental care had been denied between Nov. 1 and June 20, 2025. Per week later, on July 13, CBC reported that 52 per cent of requests for pre-authorized dental work between November 2024 and June 2025 had been rejected. The questions on this Q&A had been submitted to Well being Canada previous to the publication of the CBC article.
On this Q&A, Well being Canada responds to questions on approval charges, documentation gaps, and whether or not provinces have raised the alarm.
Q1. Well being Canada says 49 per cent of preauthorization requests for complicated care had been denied. Are you able to break that down by process — for instance, are crowns extra prone to be denied than root canals or partial dentures?
This determine represents the proportion of denied requests for preauthorization, not for submitted claims. It’s necessary to notice that, total, only one per cent of claims submitted to the CDCP thus far have been for providers that require preauthorization.
The time limit common cited within the Canadian Affairs article consists of: Requests with incomplete submissions, which continues to have an effect on the denial price, requests for providers not eligible underneath the plan, and requests which might be duplicates (e.g. could have been accredited as soon as however the subsequent ones will likely be denied) in addition to these which might be prepared for full evaluation and eligible underneath the plan. The approval price varies day by day or weekly relying on what’s submitted.
Throughout the common there may be additionally important variation by process as you counsel – some which have fewer full submissions, like crowns, or extra full submissions like partial dentures, or are exclusions from the plan (and so will at all times have a 100 per cent denial price). As well as, guidelines range for every medical process so the approval/denial charges can be anticipated to range as effectively.
Q2. What’s the common processing time for a pre-authorization request? Has Well being Canada set benchmarks or timelines for enchancment?
As of the week ending July 11, over 80 per cent of preauthorizations are being processed inside seven days.
We acknowledge that Solar Life has skilled a excessive quantity of preauthorization requests since consumption started in November. Well being Canada units out the foundations for processing all CDCP claims, together with necessities for the right way to adjudicate preauthorization requests. A number of elements have contributed to longer than anticipated wait instances, together with an unexpectedly excessive quantity of incomplete submissions and resubmissions, which require follow-up with suppliers and extra time to ship and obtain the knowledge wanted. Different elements embrace transit time for mailed in paper submissions.
Important enchancment has been seen since November when providers requiring preauthorization turned out there. Well being Canada and Solar Life proceed to work to enhance response time.
Learn associated article: The Canada Dental Care Plan: Lacking items – A commentary on the nationwide dental program
LISTEN: What Must Change for the CDCP to Work
Q3. Is Well being Canada contemplating increasing automated protection to incorporate sure pressing or routine complicated procedures — like single-unit crowns on molars or front-tooth root canals — to cut back delays?
Commonplace root canal therapy on anterior tooth, bicuspids, and first and second molars don’t require preauthorization underneath the CDCP.
Single-unit crowns are included within the CDCP however require preauthorization and should meet particular CDCP coverage standards.
The CDCP Dental Advantages Information offers extra details about the CDCP protection, insurance policies and guidelines. The CDCP Advantages Information was developed by factoring in quite a few concerns, together with the recommendation of dental specialists, the present oral well being care context, analysis proof, patterns of practices, trade traits and worldwide comparisons, in addition to comparability to and classes realized in different longstanding federal, provincial, and territorial applications.
As a part of a steady enchancment method, the CDCP will likely be reviewed recurrently primarily based on knowledge and proof to make sure it continues to satisfy the wants of Canadians.
This autumn. What are the commonest documentation gaps that result in incomplete submissions? Might you present a guidelines or steerage that dentists typically miss?
The documentation required varies by the kind of process (which is printed within the CDCP Dental Advantages Information). We’ve seen important enchancment within the variety of full submissions being acquired in latest months, however generally lacking documentation consists of radiographs, periodontal charting data, and therapy plan particulars.
Well being Canada has made instruments out there to assist inform suppliers on submitting profitable claims, together with:
- extra checklists;
- tutorial movies to assist help oral well being suppliers in submitting a preauthorization; and
- up to date narratives within the rationalization of profit statements for suppliers to make clear the main points of the choice and, the place relevant, documentation required if the submission was incomplete.
All the preauthorization sources talked about above can be found on the Canadian Dental Care Plan supplier webpage: Canadian Dental Care Plan suppliers: Preauthorization sources – Canada.ca
Q5. What sorts of inner discussions are going down between Well being Canada and Solar Life to streamline the authorization course of?
For the reason that launch of the preauthorization in November 2024, Well being Canada and Solar Life have and can proceed to take steps to assist streamline the method the place doable and scale back processing instances (for instance, to streamline the variety of adjudication steps). Well being Canada has made adjustments to the Rationalization of Advantages to incorporate extra data on denied claims and has elevated staffing.
Well being Canada and Solar Life additionally labored collectively to tell oral well being suppliers and supplied instruments (please see our response to This autumn for particulars) and knowledge classes to assist suppliers find out about CDCP necessities previous to and after launch of preauthorization underneath the CDCP. There have been important enhancements when it comes to oral well being suppliers submitting all of the wanted documentation (which hurries up the evaluation and eliminates the necessity for forwards and backwards with Solar Life on a request), in addition to in processing instances.
Q6. Have any provinces raised issues to your workplace about denial charges or affected person care delays? In that case, which provinces and what points have they flagged?
No. Well being Canada continues to interact recurrently with provinces and territories concerning the implementation of the CDCP, the intersection of the CDCP with the provincial and territorial dental applications, and different gadgets of widespread curiosity.
Q7. Are you monitoring what number of sufferers abandon therapy as a result of declare denials or delays? Are you able to share any early knowledge or affected person suggestions?
Well being Canada doesn’t monitor this knowledge.
Q8. Is there a correlation between declare rejection charges and supplier dropout or hesitation to register? What does your knowledge present about retention or onboarding of dental professionals?
As of Could 23, 2025, over 25,600 suppliers are taking part within the CDCP. Solely 17 suppliers deregistered from the CDCP and haven’t submitted any claims since deregistering.
Q9. Funds 2023 outlined the Authorities of Canada’s plan to speculate $13 billion over 5 years — together with $4.4 billion ongoing — to implement the CDCP. Is the present spending on the CDCP monitoring inside these projections? Are there issues about prices exceeding the deliberate funding?
Our costing and forecasting is strong. We’re assured in our estimates and that the plan is sustainable.
