Insurance Claim Form & Billing Set-Up

Steps to obtain a UIN:

1. Join the Independent Practice Network (IPN). An additional $95 fee applies. This membership must be renewed annually by October 31.
2. Submit the UIN Application Form with a copy of your active license from your regulatory body.

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.

Steps to set up EDI billing (CDHAnet^TM)

1. Join the Independent Practice Network (IPN). An additional $95 fee applies. This membership must be renewed annually by October 31.
2. 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.


3. Choose a software.
4. Submit the CDHAnet^TM 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.
5. Review the links under "Set Up Direct Deposit" for third party adjudicators such as Express Scripts. A few insurance companies like Alberta Blue Cross, Medavie Blue Cross and Pacific Blue Cross require enrollment as a dental provider prior to the submission of your first claim.

What is CDHAnet^TM?
CDHAnet^TM 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 (CDHAnet^TM)?
To be eligible for CDHAnet^TM, 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.

1. OPTION 1: CCDWS COMPATIBLE WITH TELUS & INSTREAM
   No cost and no additional registration associated with the network. However, you must have "CCDWS" certified software.
2. 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.

Steps to set up direct deposit

1. Obtain a UIN and CDHAnet^TM office number.
2. NEW!! Submit Dental Hygienist Provider Enrolment Form directly to Express Scripts.
3. Register directly through TELUS Provider Network Registry.
4. Other insurance companies to register with:
   • Sun Life Direct
   • Alberta Blue Cross
   • Medavie Blue Cross
   • Pacific Blue Cross
   • NexGenRX
   • Claimsecure
   • providerConnect
5. 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.
6. Enroll as a Canadian Dental Care Plan (CDCP) provider. Learn more about CDCP.
7. Enroll as a provider for NIHB through Express Scripts. To learn more, see the next tab under NIHB or go to their website.

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

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
• Manulife Financial (in transition)
• RWAM Insurance Administrators

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.

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?

1. 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.
2. For changes to your CDHAnet information, submit a CDHAnet^TM Account Update Form.
   (Note: All providers of the CDHA-ACHDnet^TM 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.


3. ^*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

Note: Other insurance companies or third-party provider portals may need to be updated once you have updated with CDHA.

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.

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

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