CDCP Clawbacks – What You Need to Know

The Canadian Dental Care Plan (CDCP) has created a significant shift in how practices across Canada operate, particularly when it comes to documentation and billing. As practices adapt to CDCP protocols, it’s essential to be aware of the potential risks involved—specifically, clawbacks.

At DentaVate, we believe in staying ahead of the curve and protecting your practice from unnecessary stress and financial strain. Here’s what you need to know:

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⚠️ What Are Clawbacks?

A clawback is the recovery of funds that were previously paid out to a provider, typically due to issues discovered during chart audits. These can occur when documentation is considered incomplete, insufficient, or unjustified for the treatment billed.

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📋 Common Audit Triggers for Clawbacks

Based on emerging patterns across dental offices, the following are some of the key areas under scrutiny:

• Insufficient Documentation: If the clinical notes don’t support the treatment billed, a clawback may be initiated. Simply listing the treatment is not enough—there must be clear justification.

• Unnecessary Fluoride Applications: Fluoride treatments are being questioned if there’s no evident clinical need or rationale documented.

• Incomplete Charting: Omissions in chart entries (such as missing consent, treatment details, or dates) are being flagged, and may be used as grounds for repayment demands.

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🚫 Risk of Being Blocked by Sun Life

In more severe cases, non-compliance with CDCP documentation standards could potentially result in your clinic being blocked from both CDCP and private insurance payments through Sun Life. This underscores the importance of maintaining pristine records—not just to avoid clawbacks, but to preserve access to essential reimbursement streams.

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✅ How to Protect Your Practice

To reduce your risk of clawbacks and ensure long-term sustainability, consider the following:

1. Improve Clinical Documentation

Every treatment note should tell the story of why the treatment was necessary. Be specific, thorough, and consistent.

2. Justify Preventive Services

Document the clinical need for preventive treatments like fluoride. Include caries risk assessments and patient history.

3. Standardize Charting Protocols

Implement systems to ensure every chart is complete before the patient leaves. Use checklists and regular audits to stay on track.

4. Train Your Team

Ensure all staff members involved in clinical documentation and billing understand the CDCP requirements.

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🛡️ DentaVate Can Help

Navigating CDCP expectations can feel overwhelming—but you don’t have to do it alone. At DentaVate, we offer consulting and team training to help your clinic stay compliant, audit-ready, and confident.

Let’s work together to safeguard your practice against clawbacks and stay one step ahead of changing regulations.

📞 Need help with auditing? Contact us for a custom solution.