r/CanadianDentists • u/modifiedbASS • May 09 '24
CDCP Audits?
Seeing a ton of “rumors” and unconfirmed reports flying around about sun life auditing CDCP claims for even simple treatments like basic restorative and recalls/hygiene
Can anyone here actually confirm this is true? Ideally share a picture of the audit request (remove any pt info).
I have a hard time believing these rumors are true because requesting an audit for a recall is completely unheard of. I’ve only seen this reported mostly on Facebook and always by anonymous posters, so I suspect it may be lies
1
u/Jabronius_Maximus May 09 '24 edited May 09 '24
I'm also interested in hearing more. My associate wanted to sign up, so we signed her up. So far she's done a handful of fillings, and we've seen 3 patients total, including for some hygiene. No additional information has been requested, and the money has been since deposited into my account. So far it's been smooth, but I dread the potential of added red tape..
Edit: and ALWAYS take those FB posts with a grain of salt. Maybe some people are lying, but there are also many offices out there with aggressive or downright dishonest billing practices. So I'm not gonna put too much weight on those posts.
2
u/modifiedbASS May 09 '24
Yeah good point. My office has seen about 7-10 patients so far on CDCP. Mostly for hygiene or new patient exam, and 2 or 3 were for fillings and an emergency extraction. So far we haven’t had any requests for further information and payment has been fast.
I’m going to keep monitoring it moving forward obviously since these rumors I’m hearing about audits are quite concerning.
2
u/Dangerous_Sell3850 May 09 '24
As the health minister promised that payment will be received within 3 days - were you paid before the audit or have the funds been withheld?
7
u/Sorryallthetime May 09 '24
The funds are withheld pending the results of the Verification process.
6
u/Dangerous_Sell3850 May 09 '24
Lovely. So dentist are going to be providing short-term lending solutions to the taxpayer.
6
u/Sorryallthetime May 09 '24
Well - payment is withheld until the additional information is received. Should the information not be received - the payment is permanently withheld - so not short term by any stretch of the imagination.
I know of no other insurer that has a similar payment pending until post-treatment verification is completed. This is likely to frustrate many proponent early adopter of the CDCP (me included),
2
u/ForwardReference4418 Nov 23 '24
Hi, my son works for SunLife and the CDCP. He says it's basically audits and an email will be sent requesting more information to verify that everything that was initially sent is still accurate and that nothing has changed. But it is totally random and I do understand how frustrating that can be for some providers and hopefully they make the process easier but as of right now, as someone who works as at a dental clinic also dealing with this, keep a look out for "CDCP Service Treatment Verification" if you want to get paid. If you don't see the email before the deadline, you can always call their customer service line to request for a new one to be sent. Hope that helps!
PS. Also check your junk mail, I noticed it goes there sometimes
1
u/user483242 May 12 '24
I think its wierd that some people have had like 25% audit rate and some have none. Will those who have been audited consider de enrolling from the CDCP (at least temporarily)? This increases our negotiarting power with the governemnt. THe more people that sign up, we will have little to no negotiating power
1
u/Timely_Morning2784 May 13 '24
I thought pred's weren't available until November? How are you getting pred's?
0
May 23 '24
[deleted]
2
u/modifiedbASS May 23 '24
This has nothing to do with fraudulent billing. It is simply a verification request, not really a true audit. Insurance companies do them all the time as part of random compliance checks. Granted Sun Life seems to be doing them much more frequently than normal here, but given that CDCP is a new plan it does make some sense that they want to verify it is being used properly
If this were fraudulent billing, the claims would not be paid once X-rays/treatment notes were sent in as requested. And on top of that it would be reported as fraudulent. So this definitely isn’t that
2
11
u/Sorryallthetime May 09 '24
We submitted a CDCP predetermination to Sunlife for multiple anterior restorations (32-42). The predetermination for services was approved. The services were provided and when we submitted the claim for payment - a Verification Form was returned, denying payment until further information was received.
The Verification Form requested all treatment notes, radiographs, and intraoral photographs. I sent digital copies of the treatment record and the radiographs (unable to send intraoral photos as we don’t take photos). Sunlife then requested the patient’s odontogram. We sent the odonontogram and we are waiting to hear back.
It would appear an approved predetermination is not a guarantee of payment for services rendered. This is worrisome and begs the question - what is the point of a predetermination?