Cleft Palate and Craniofacial Clinical Resources

An MSP number is required is required to apply for orthodontic program eligibility. If you do not have an MSP number, follow the application instructions on the B.C. government website. If you have a previous MSP number from work as a general dentist you will need to apply again as a certified specialist.

Eligibility for the MPS orthodontic program is influenced by a patient’s diagnosis, previous treatment, and future treatment needs. Not all patients with clefts or craniofacial differences will be eligible. Understanding these eligibility criteria will help you speak with patient families regarding whether their treatment is likely to be covered or not.

In general, patients eligible for the MSP orthodontic program must meet one of the following criteria:

• Latrogenic malocclusion resulting from a medically necessary surgical intervention. Patients who had surgical repair of cleft lip/palate fall into this category. Note that this means that patients with clefts that did not require surgery (e.g., submucous cleft palate) may not be eligible for coverage.
• Patients with congenital craniofacial syndromes who require orthognathic surgery. Coverage may also be approved for these patients when the goal of orthodontic treatment is to prevent the need for future orthognathic surgery.

If you believe your patient is eligible, you must complete an eligibility request (PDF). 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
Fax: 250-405-3588
Alternative fax: 250-405-3590

Once your request is reviewed, you will receive confirmation from MSP detailing what coverage is approved. You should save this document in your patient’s chart, as it has information you will need in order to submit your MSP billings. 

Approved fee codes for preparatory procedures (examination, diagnosis, treatment planning) may be billed as soon as they are rendered. Approved fees for treatment phases are generally split into four parts: one at initial bonding and three quarterly fees. You will need to submit MSP billing forms at each of these intervals in order to be paid (i.e. quarterly payments are not automatic). 

To submit your MSP billings, complete the pay dentist claim form (PDF). This form must be filled out electronically and submitted by mail. 

• Complete the patient information section
  • You may leave blank: MVA related, MVA Claim Number, Correspondence Attached, and Plan Reference Number
• Complete the services section
  • You may leave blank: SCC, Called Start, and Rendered Finish
  • Leave the tooth chart blank
  • Enter 'A' for Location of Services for all items
  • Enter the appropriate ICD9 Diagnostic Code (PDF) for your patient on each item
  • Enter the billing code(s) which were requested/approved in the previous steps in the Fee Item columns, the date that the service was provided, and the corresponding fee in Amount Billed
    • Use the fee listed on the coverage confirmation you received if available. When not supplied, use the fee from the fee guide
    • Do not enter the '.' between the dollars and cents of the fee, or the form will truncate your entry
• Complete practitioner information section
  • You may leave the 'Referred by' sections blank
  • The specialty code for orthodontists is '42' 

Billing extended treatment/recurring items

• For subsequent quarterly fees, submit a new pay dentist claim (PDF) at three month intervals until all of the quarterly fees have been paid.
• On each subsequent form, enter the service date at three month intervals from the initial bonding/first treatment fee.
• If you enter an earlier date than the three month interval, your billing may be declined.