What Ophi has done for the clinic
In progress
$7,064.35 of crown treatment is moving through 14 open preauthorizations.
- Needs the patient · 2 cases$581
- Paperwork · 5 cases$2,684.90
- Dentist review · 2 cases$581
- Ready to send · 1 case$581
- With Sun Life · 2 cases$1,210.45
- Book the crown · 1 case$581
- Resubmit · 1 case$845
Caught before sending
Ophi found 2 missing or out-of-date documents on 2 cases before they reached Sun Life.
Needed the patient
- Dated complete periodontal chart, within 12 months2
Sun Life's decisions
4 sent with a complete, signed packet, $2,636.45 of treatment. Sun Life approved 1 ($581) and denied 1 ($845). 2 are waiting.
Past denials
1 past denials were never resubmitted, $845 of treatment. None are rebooking yet; 0 are on the call list.
1 crown off that list is planned again and back on the board, $845 of treatment. Each still needs a new preauthorization before it can be sent.
Staff time
About 5.8 hours of checking charts against the CDCP rules, across 14 cases.
Estimate: 25 minutes per preauthorization by hand.
Last 12 months
The clinic sent 2 crown preauthorizations. Sun Life denied 1, $845 of treatment; 0 of those were missing a document CDCP requires, and 1 were never resubmitted.
Every request, with what was missing
| Patient | Crown | Sent | Decision | Fee | Missing when sent | Resubmitted |
|---|---|---|---|---|---|---|
| SUMI YOKOYAMA | #24 (27211) | Sep 10, 2026 | Denied | $845 | None found Sun Life: Predetermination not approved. A current periapical radiograph of tooth 24 was not received. Resubmit with the radiograph. |
No |
| KRIS RANDAL | #26 (27211) | Sep 8, 2026 | Approved | $581 | None found Sun Life: Predetermination approved. Valid for 12 months from this date. |
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