Cleft Palate and Craniofacial Clinical Resources

You need an MSP number to apply for orthodontic program eligibility. If you do not have an MSP number, follow the application instructions on the BC 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 MSP 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 about whether or not their treatment is likely to be covered.

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. MSP may also approve coverage 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 you must complete this for every billing code 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 the financial arrangements section. When completing these sections, make sure you adequately describe the presenting condition, treatment plan and future treatment needs to demonstrate that your patient meets the eligibility criteria. 
 

• If you are not performing any treatment (i.e. examination only), describe the reason for examination and findings in the treatment plan box instead
• You can estimate treatment commencement and retention dates if they are in the future or leave them blank if you are not recommending any treatment at this time
• Write any fee codes that are not in 'A. Preparatory Procedures' into 'B. Treatment Procedures'.
  • This includes codes such as between-phase observations or serial extraction guidance

You must include the most recent cleft and craniofacial team report with your coverage request, because MSP uses it 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 MSP has reviewed your request, you will receive confirmation from them detailing what coverage is approved. Save this document in your patient’s chart, as it has information you will need in order to submit your MSP billings. 

You may bill approved fee codes for preparatory procedures (examination, diagnosis, treatment planning) as soon as they are rendered. MSP generally splits approved fees for treatment phases 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). You must fill this form out electronically and submit it 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) that 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 MSP has paid all of the quarterly fees
• 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, MSP may decline your billing