If you believe your patient is eligible, you must complete aneligibility request
(PDF download). Note that this must be completed for every billing code that you wish to submit. This means re-submitting this form for each exam, phase of treatment etc.
Fully complete the patient information, orthodontist Information, and medical diagnosis sections. Using the current fee guide
, complete the relevant cleft lip/palate or congenital craniofacial section, and financial arrangements section. When completing these sections, ensure you adequately described the presenting condition, treatment plan, and future treatment needs to demonstrate that your patient meets the eligibility criteria.
- If no treatment is being performed (i.e., examination only), describe the reason for examination and findings in the treatment plan box instead.
- Treatment commencement and retention dates can be estimated if they are in the future, or left blank if no treatment is recommended at this time.
- Any fee codes which are not in 'A. Preparatory Procedures' should be written into 'B. Treatment Procedures'.
- This includes codes such as between-phase observations or serial extraction guidance.
Coverage requests must be accompanied by the most recent cleft and craniofacial team report, which MSP uses to confirm eligibility. If you do not have a copy of your patient's most recent team report, contact the responsible team:
- BC Children's cleft and craniofacial team: 604-875-3146
- Kelowna cleft team: 250-469-7070, ext. 12122
- Island cleft team: 250-519-5390, ext. 36329
Submit the completed MSP orthodontic program eligibility request form and the accompanying team report for review to:
MSP, ATTN: Orthodontics
Alternative fax: 250-405-3590