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 occasions 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 have 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 have 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 have 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 share of denied requests for preauthorization, not for submitted claims. It’s essential to notice that, total, just one per cent of claims submitted to the CDCP thus far have been for companies 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 companies not eligible underneath the plan, and requests which can be duplicates (e.g. might have been permitted as soon as however the subsequent ones might be denied) in addition to these which can be prepared for full overview and eligible underneath the plan. The approval price varies every day or weekly relying on what’s submitted.
Inside the common there’s additionally vital 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 scientific process so the approval/denial charges could 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 way to adjudicate preauthorization requests. A number of components have contributed to longer than anticipated wait occasions, 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 components embody transit time for mailed in paper submissions.
Vital enchancment has been seen since November when companies requiring preauthorization turned obtainable. 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 scale back delays?
Customary root canal remedy on anterior enamel, 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 gives 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, business tendencies and worldwide comparisons, in addition to comparability to and classes discovered in different longstanding federal, provincial, and territorial packages.
As a part of a steady enchancment strategy, the CDCP might be reviewed commonly primarily based on knowledge and proof to make sure it continues to fulfill the wants of Canadians.
This autumn. What are the most typical documentation gaps that result in incomplete submissions? Might you present a guidelines or steering that dentists usually miss?
The documentation required varies by the kind of process (which is printed within the CDCP Dental Advantages Information). We now have seen vital enchancment within the variety of full submissions being acquired in latest months, however generally lacking documentation consists of radiographs, periodontal charting data, and remedy plan particulars.
Well being Canada has made instruments obtainable 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.
The entire preauthorization assets talked about above can be found on the Canadian Dental Care Plan supplier webpage: Canadian Dental Care Plan suppliers: Preauthorization assets – Canada.ca
Q5. What sorts of inside discussions are happening 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 potential and scale back processing occasions (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 periods to assist suppliers study CDCP necessities previous to and after launch of preauthorization underneath the CDCP. There have been vital enhancements when it comes to oral well being suppliers submitting all of the wanted documentation (which hurries up the overview and eliminates the necessity for forwards and backwards with Solar Life on a request), in addition to in processing occasions.
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 commonly with provinces and territories in regards to the implementation of the CDCP, the intersection of the CDCP with the provincial and territorial dental packages, and different objects of widespread curiosity.
Q7. Are you monitoring what number of sufferers abandon remedy on account of declare denials or delays? Are you able to share any early knowledge or affected person suggestions?
Well being Canada doesn’t observe 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 Might 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. Finances 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.
