Claim Form & Billing Set-Up
This page provides information for Independent Practice Network (IPN) members on the
claim
forms used for billing and how to submit claims, set up electronic billing with
CDHA-ACDHnetTM,
commonly known as CDHAnetTM, and direct deposit, update your business information, and
register
with the Non-Insured Health Benefits (NIHB) program.
CDHA National Dental Hygiene Claim Form
CDHA’s National Dental Hygiene Claim Form is for the use of independent dental hygienists.
Completed claim forms may be printed and submitted by mail to the insurance companies, either by the client
or by the dental hygienist on behalf of their client. To submit claims electronically (EDI), you must
purchase appropriate software and enrol in CDHAnet™.
Visit CDHA’s Insurance
Claims Support page for more details as well as insurance company contact information.
*It’s important to determine ahead of time if your client’s dental benefits plan accepts
independent dental hygienists as eligible health care providers.
CDHA Standard Dental Hygiene Referral Form
Completed forms may be printed and used by the dental hygienist when referring clients to other health care
professionals.
Billing
To avoid delay in the processing of your forms please read: Important
Tips
How to Obtain a UIN (Provider Number)
What is a Unique Identification Number (UIN)?
A unique identification number (UIN), provided by CDHA, identifies you as the dental
hygiene provider if you submit oral health claims to the insurance carriers. Only
you can use your UIN. It is not transferrable. The CDHA UIN consists of 9 unique
numbers, starting with “202,” that identify you to the insurance carriers. The CDHA
roster of members' UINs must be current and accurate and renewed each year with your
IPN membership renewal.
Do I need a UIN?
If you will be submitting claims to insurance companies for payment, either by you
as the provider or on behalf of your client, you will need a CDHA UIN, also known as
a provider number. This identifies you as an eligible health care provider to
insurance companies. Your UIN is unique to you as a provider and should not be
shared with other health care providers.
What do I need to qualify for a UIN?
You must meet all requirements of your provincial regulatory body to practise as an
independent dental hygienist. You will be asked to submit a copy of your active
licence from your regulatory body with your UIN application form.
How do insurance companies know I’m an eligible provider?
CDHA sends a list containing the name, UIN, and contact information of our eligible
independent dental hygiene providers weekly to all insurance companies. Some
insurance companies require you to register with them as a provider separately,
including Medavie Blue Cross, Alberta Blue Cross, and Pacific
Blue Cross. Other insurance companies may only activate an independent
dental hygienist in their system upon receipt of their first claim.
Note: UIN applications are processed once a week, on Tuesdays. Only completed
applications received by Monday, 12:00 pm ET
will be included in Tuesday’s processing. Those received after will be processed
the following week.
How to set up EDI billing (CDHAnet™)
What is CDHAnetTM?
CDHAnetTM is the network managed by CDHA to transmit electronic claims
from independent dental hygienists to the insurance carriers. It is the only network
that is configured to accept electronic dental hygiene claims.
What do I need to bill through EDI (CDHAnetTM)?
To be eligible for CDHAnetTM, you must be a member of CDHA’s Independent
Practice Network (IPN), have an active UIN, internet access and practice management
software.
What are my software options?
TELUS and Instream are the network messaging services that CDHAnetTM uses to send
your claims to insurance companies for processing. When choosing a software, you
will need to consider which network messaging service supports your preferred
software. Both options listed below access all insurance companies who accept EDI
claims from independent dental hygienists. Please note there is an additional annual
registration fee for Option 2.
- OPTION 1: CCDWS COMPATIBLE WITH TELUS & INSTREAM
No cost and no additional registration associated with the network. However, you
must have "CCDWS" certified software.
- OPTION 2: ICA INSTREAM ONLY
Register and pay a $180 annual subscription fee through Instream.
You must have
Instream compatible software.
What insurance companies accept EDI claims from independent dental
hygienists?
Over 40 insurance companies accept EDI claims from independent dental hygienists,
including Sun Life, Manulife, Canada
Life, and Green Shield Canada. See our e-claims support document for further details.
What is Express Scripts?
While some insurance companies process their claims directly, others use a
third-party claims adjudicator, such as Express Scripts Canada. Express Scripts
Canada is the third largest health care claims adjudicator in Canada and facilitates
electronic claims from independent dental hygienists, including real-time processing
and electronic funds transfer (EFT) (direct deposit) for the following insurance
companies:
- Benecaid
- Cowan Insurance Group
- GMS Insurance Inc
- GPM
- Group Medical Services
- Humania Assurance Company
- Johnson
- SFMM
Express Scripts Provider Manual
Express Scripts Enrolment Letter
Steps to set up EDI billing (CDHAnetTM)
- Join the Independent
Practice Network (IPN). An additional $95 fee applies.
This membership must be renewed annually by October 31.
- Submit the UIN Application Form.
UIN applications are processed once a week, on Tuesdays. Only completed
applications received by Monday, 12:00 pm ET
will be included in Tuesday’s processing. Those received after will be
processed the following week.
- Choose a software.
- Submit the CDHAnetTM Application Form.
CDHAnet™ applications are processed once a week, on Tuesdays.
Completed applications must be received by Monday, 12:00 pm ET to be
included in Tuesday’s processing. Those received after will be processed the
following week.
- You will be assigned and sent a CDHAnetTM office number (###H) by
email along with next steps for software set up.
- Submit Express Scripts Application Form with a void cheque or
bank letter.
Express Scripts applications are processed once a week, on Tuesdays.
Completed applications must be received by Monday, 12:00 pm ET to be
included in Tuesday’s processing. Those received after will be processed the
following week.
Set Up Direct Deposit
What is Express Scripts?
Express Scripts Canada facilitates e-claims from independent dental hygienists,
including real-time processing and electronic funds transfer (EFT) (direct deposit)
for the following insurance companies:
- Benecaid
- Cowan Insurance Group
- GMS Insurance Inc
- GPM
- Group Medical Services
- Humania Assurance Co
- Johnson
- SFMM
Express Scripts Provider Manual
Express Scripts Enrolment Letter
What is the TELUS Provider Network Registry for Direct
Deposit?
The TELUS Provider Registry offers dental hygienists the opportunity to sign up for
direct deposit through secure email. This option is available to all CDHAnet™ users.
Not only will you receive payment faster, but the bulk payment will be directly
deposited into your office bank account and will include reimbursement for all
dental hygienist providers who practise in your office. You will also receive an
electronic statement. This service will streamline payment to your office and
eliminate the need for part-time dental hygiene contractors to endorse insurance
cheques.
TELUS offers direct deposit for the following insurance companies:
- Benefits Trust
- Canada Life
- Group Health
- Group Source
- Manion
TELUS Provider Network Registry
Contact TELUS Health at 1-866-240-7492, option 5, or provider.mgmt@telus.com for questions
or difficulties with set-up.
What other insurance companies provide direct deposit?*
Sun Life provides convenient online services through Sun Life Direct. Please visit
the Sun Life Direct website and follow the steps. Sun Life Direct offers the
following services:
- Daily direct deposit
- Coverage look-up
- Online payment statements
- Online dental estimates
Other insurance companies who offer direct deposit upon registration are:
*You may wish to check individual insurance company websites that are not
included here to see if they offer a provider registry option for direct deposit.
Steps to set up direct deposit
- Obtain a UIN and CDHAnetTM office number.
- Submit Express Scripts Provider Enrolment Form with a void
cheque or bank letter.
Express Scripts applications are processed once a week, on Tuesdays.
Completed applications must be received by Monday, 12:00 pm ET to be
included in Tuesday’s processing. Those received after will be processed the
following week.
- Register directly through TELUS Provider Network Registry.
- Other insurance companies to register with:
How to update CDHAnet™ account information (address, phone number, software, etc.)
Why do I need to keep my business information up to date?
CDHA sends weekly lists to insurance companies with provider information. It is
important to keep this information up to date so that insurance companies have
accurate data in their systems to prevent delays in claims processing.
How do I update existing business information with CDHA?
- To change business information for your UIN, go to the My Business Info
section of your CDHA profile
and edit your business information right in your profile.
- For changes to your CDHAnet information, submit a CDHAnetTM Account Update Form.
(Note: All providers of the CDHA-ACHDnetTM must sign the form to
authorize the updates.)
CDHAnet™ applications are processed once a week, on Tuesdays.
Completed applications must be received by Monday, 12:00 pm ET to be
included in Tuesday’s processing. Those received after will be processed the
following week.
- *Submit an Express Scripts Modification Form (Note: this form is
submitted directly to Express Scripts)
*only required if you are signed up with Express Scripts
Non-Insured Health Benefits (NIHB) Program
What is NIHB?
Health Canada’s Non-Insured Health Benefits (NIHB) program provides coverage for
benefit claims for eligible First Nations and Inuit peoples. In all provinces where
dental hygienists can practise independently, dental hygienists can submit procedure
claims as independent oral health care service providers. For more information,
please download the Welcome Letter from NIHB (français) and the quick reference guide.
More detailed information on the NIHB program, including policy and program
information, provincial dental benefit grids, and quarterly newsletter, can be found
here.
Note: ensure you click on the link that contains HY-NIHB in the title of the
dental benefit grid for your province to ensure you are seeing the dental hygiene
grid.
How do I enrol in the NIHB program?
To enrol, please visit https://nihb.express-scripts.ca/NIHBProvider/benefits/dental.
Please note that enrolment in this program is done through Express Scripts Canada.
Note for our members in British Columbia:
First Nations Health Authority (FNHA) claims and pre-authorizations are submitted
through Pacific Blue Cross (PBC) rather than NIHB/Express Scripts Canada
Having issues with submitting claims? Troubleshooting steps:
- Contact the insurance
company
- Contact your software vendor
- Contact your messaging service (TELUS or instream)
- Contact CDHA
Questions for CDHA:
Phone: 1-800-267-5235 or (613) 224-5515 x300
Email: independentpractice@cdha.ca