What is the CDCP reconsideration window for denied claims?

Practices have 60 days from the date of a CDCP claim decision to submit a reconsideration request to Sun Life, the plan's claims administrator, before that window closes.

Does the CDCP require pre-authorization?

Yes. Certain procedure categories under the Canadian Dental Care Plan require pre-authorization before treatment, and claims submitted without it can be denied outright.

What is the CDCP fee grid ceiling?

CDCP reimburses providers up to a percentage of the federally published fee grid (around 90% in most provinces), which is often lower than a practice's standard fee schedule — the difference shows up as a variance on reconciliation rather than a straightforward denial.

Who do I call about a CDCP claim status?

CDCP claims are adjudicated through Sun Life's dedicated provider contact centre, separate from Sun Life's regular group benefits line.

Canadian Dental Care Plan

CDCP Claims Are Piling Up — Here's What's Actually Slowing Your AR Down

The Canadian Dental Care Plan (CDCP) added a new federal payer to nearly every practice's claim mix. It runs on its own rules — a different reconsideration clock, a different fee ceiling, and pre-authorization requirements that don't exist with private carriers. Here's what to watch for, and how to keep CDCP claims from quietly aging into write-offs.

CDCP isn't a private carrier — it's adjudicated through Sun Life

The CDCP is a federal program, but day-to-day claim adjudication runs through Sun Life via a dedicated CDCP provider contact centre — separate from Sun Life's regular group benefits line. If your front desk is calling the number on a patient's old Sun Life card, they're likely in the wrong queue, which is one of the most common reasons CDCP claim-status calls go nowhere.

CDCP at a glance

Administrator: Sun Life (dedicated CDCP provider line)
Pre-authorization: Required for certain procedure categories — missing preauth is an outright denial
Reconsideration window: 60 days from the date of decision
Fee grid ceiling: ~90% of the federal fee grid — often below your standard fee schedule
Coverage tiers: Preventive 100% · Basic 80% · Major 50% · Orthodontic 0%
Deductible: None

Where CDCP claims actually get stuck

Pre-auth gaps. A procedure that would auto-adjudicate under a private plan gets denied outright under CDCP if pre-authorization wasn't filed first — and that denial often arrives with little explanation.
The 60-day reconsideration clock. Unlike most private carriers, CDCP gives you a hard 60-day window to request reconsideration after a decision. Miss it, and the claim is closed — permanently, not just delayed.
Fee grid variance, not denial. A claim can come back "paid" but at ~90% of the federal fee grid rather than your billed amount. That's not a denial your team will flag — it just quietly reduces what's collected, claim after claim, unless someone's reconciling against the original estimate.

What this means for your front desk

Every CDCP claim now needs the same follow-up discipline as a private carrier claim — a status check if it's been sitting too long, a reconsideration filed within 60 days if it's denied, and a reconciliation pass to catch fee-grid variances. For a practice with a meaningful CDCP-eligible patient base, that's a second full follow-up workflow stacked on top of the six private carriers your team already chases.

How CollectRx handles CDCP

CollectRx already routes CDCP claims through their own recovery path — the same AI follow-up that calls Sun Life, Canada Life, Manulife, Green Shield, RBC, and TELUS AdjudiCare for status updates also tracks CDCP claims against the dedicated CDCP queue, flags claims that are CDCP-reconsideration eligible before the 60-day window closes, and reconciles paid amounts against the federal fee grid ceiling so fee-grid variances surface as a number, not a surprise at month-end.

See what CDCP follow-up could look like for your practice

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