CDAnet/CDA ITRANS Claims Service Schedule

Version 1.0, Dated June 27, 2018

 

Clicking the “I AGREE” button that appears at the end of this Service Schedule means that You agree to be bound by it and this Service Schedule becomes part of the CDA Practice Support Services Subscriber Agreement (the “Subscriber Agreement”) that You entered into. You also agree that this agreement replaces any previous subscriber agreements for CDAnet and/or ITRANS that you may have made with CDA. “You” means the person who is a party to the Subscriber Agreement and who subscribes to or requests a subscription for CDAnet and ITRANS under this Service Schedule.

CDA makes CDAnet and ITRANS available to You pursuant to the Subscriber Agreement and this Service Schedule. Depending on how the practice management software that You use is configured, You may or may not be using ITRANS. You should discuss how your practice management software is configured with your independent software vendor. “Services” means every aspect of CDAnet and ITRANS that You use or that your practice management software is configured to use.

PLEASE NOTE: If You practice at more than one location You must enter into a separate Service Schedule for each location. Dental Benefit Claims for two or more physical practice locations cannot be combined into a single stream of claims that appears to be coming from one location.

1. Overview

1.1 Capitalised terms used but not defined in this Service Schedule have the meanings assigned to them in the Subscriber Agreement.

1.2 “CDAnet Service” or “CDAnet” means the services described as such in this Service Schedule. CDAnet is a Service that facilitates the transmission of Dental Benefit Claims. An End User may use CDAnet to format Dental Benefit Claims and to transmit them to Claims Processors. CDAnet does not include the provision of any network services, and is described in more detail in section 3.1 and section 3.2.

1.3 “CDA ITRANS Claims Service” or “ITRANS” means the services described as such in this Service Schedule. ITRANS is a claims transmission service. ITRANS works with and supplements CDAnet by transmitting Dental Benefit Claims to Claims Processors over the Internet. ITRANS is described in more detail in section 3.1 and section 3.3.

1.4 “Dental Benefit Claim” means a claim for dental benefits submitted by You using CDAnet or ITRANS to a Claims Processor for adjudication, processing, validation, payment and/or assignment (including predetermination, eligibility and all other defined CDAnet transactions). Dental Benefit Claims must be prepared in accordance with applicable CDAnet/Réseau ACDQ Standards.

1.5 “Claims Processors” are insurers and/or adjudicators who provide services related to the adjudication, processing, validation and payment of health benefit claims and who are listed under the heading “CDAnet Carrier List” at www.cdanet.ca. CDA may modify the list from time to time.

1.6 "CDAnet/Réseau ACDQ Standards" means the specifications, protocols and related business processes adopted for the definition of content, formatting, structuring and transmission, as applicable, of Dental Benefit Claims, as established from time to time by the CDA, ACDQ and CLHIA and made available to You.

2. Provision of Service

2.1 The provision of CDAnet and ITRANS to You is subject to the terms and conditions of the Agreement.

2.2 Neither CDAnet nor ITRANS includes the provision of a connection to the Internet or any other network services.

2.3 You acknowledge that CDA may use agents or subcontractors to provide software, technical support and other services as part of CDAnet or ITRANS.

3. CDAnet and ITRANS Services

3.1 Required Components for Services

(a) Practice management software packages that create and format health benefit claims based on the CDAnet/Réseau ACDQ Standards are certified by CDA. Unless You have CDA-certified practice management software licensed from an independent software vendor, You will not be able to use CDAnet or ITRANS, and CDA will not be able to activate your subscription for either CDAnet or ITRANS. You are responsible for obtaining and implementing the practice management software. The applicable software vendor may be able to help with implementation.

(b) Communication Agents are required to use CDAnet and ITRANS. A “Communication Agent” is a piece of software that manages the transfer of a Dental Benefit Claim to a network operated by or on behalf of one or more Claims Processors. The Canadian Life and Health Insurance Association (CLHIA) is responsible for the Communication Agent that is currently in use, and it is called Common Communication Driver—Web Services (the “CCD-WS”). The required Communications Agent(s) may change from time to time. Regardless, the independent software vendor who provides You with practice management software should also be able to provide You with the Communication Agent(s) that You require.

3.2 CDAnet Service

(a) Within one week of activating a subscription for CDAnet, CDA will notify the Claims Processors of the subscription. Once the Claims Processors recognize your subscription, You will be able to use CDAnet to transmit Dental Benefit Claims. Typically, Claims Processors will recognize your subscription within two weeks of receiving notice of it from CDA.

(b) When a CDAnet subscription is terminated, for any reason, CDA will inform the Claims Processors of the termination.

(c) You will ensure that all information that You provide to CDA through the PSS Website and any CDAnet forms is accurate, and You will promptly notify CDA of any change in the information for You or the Office(s) to which this Service Schedule relates. When You update that subscription information, CDA will relay the updated subscription information, if applicable, to the Claims Processors.

3.3 CDA ITRANS Claims Service

(a) This section 3.3 only applies if You use ITRANS.

(b) Depending on the version of ITRANS that You use, ITRANS Claims Director software (“ICD”) may be required. This software interacts with CDA-certified practice management software and does the following: (i) based on the applicable Claims Processor, directs Dental Benefit Claims to the appropriate network; (ii) makes a copy of the Dental Benefit Claim excluding any identifiable patient and plan member Personal Information; (iii) transmits the de-identified copy of the Dental Benefit Claim to a CDA-operated system located in Canada to enable CDA (A) to provide the support services described in this Service Schedule, and (B) to provide analysis for the administration of ITRANS and overall dental services provision activity in Canada; (iv) periodically retrieves from CDA an updated list of the appropriate transmission network for each Claims Processor; and (v) allows the practice management software that You use to access that list. CDA grants You a non-exclusive license to use the ICD (including any user documentation provided by CDA) as part of ITRANS and not for any other purpose. CDA reserves any rights in and to the ICD not expressly granted to You in this Service Schedule.

(c) You and your End Users will not:

(i) make any copies of the ICD other than copies that are reasonably necessary for the use of the ICD or to back-up the ICD;

(ii) sell, license, resell, sublicense, or otherwise permit any third parties to access or use the ICD;

(iii) remove patent, copyright, trademark or other intellectual property markings from the ICD;

(iv) modify, alter, tamper with, repair or otherwise create derivatives from the ICD;

(v) reverse engineer, disassemble or decompile the ICD;

(vi) use the ICD to transmit content or messages that are illegal, fraudulent, threatening, abusive, defamatory, or obscene; or

(vii) use the ICD to transmit any virus or other harmful code.

3.4 Your Responsibilities

(a) You and your End Users, will comply with: (i) the rules and procedures for accessing CDAnet as documented in the CDAnet Office User Guide (available at www.cdanet.ca), (ii) this Service Schedule and the Subscriber Agreement; and (iii) any other documentation governing your use of CDAnet and ITRANS that CDA makes available to You.

(b) For each Office, You will acquire and maintain all computer hardware and other equipment, software, telecommunications lines or other products or services required to enable You to use CDAnet and ITRANS. You acknowledge that You may not be able to receive and use CDAnet or ITRANS (because of compatibility issues) should computer hardware and other equipment, software, telecommunications lines or other products or services not conform to any guidelines or standards prescribed by CDA and/or your independent practice management software vendor.

(c) You shall be responsible for training your End Users, on the use of CDAnet and ITRANS.

(d) You will not permit any Person other than You and your End Users to use CDAnet and ITRANS. You and your End Users will use organizational, administrative, physical and technical means to protect your sign-in credentials (i.e. user identifications, passwords, secure tokens (CDA Digital ID) or other authentication credentials). “Person” means an individual, corporation, partnership, joint venture, association, trust, pension fund, union, governmental agency, board, tribunal, ministry or commission.

(e) Neither You nor any other End User acting on your behalf may share any sign-in credentials for CDAnet or ITRANS. There are tools for assigning and managing sign-in credentials for End Users on the PSS Website.

(f) You warrant that the electronic submission of any Dental Benefit Claim by You or any of your End Users constitutes a certification that the Claim contains an accurate and complete statement of:

(i) the dental services performed;

(ii) the date on which the services were performed;

(iii) the provider who performed the services;

(iv) the Office at which the services were performed;

(v) all the services provided at the particular appointment; and

(vi) the total fee payable, errors and omissions excepted.

3.5 Security

(a) CDA has taken steps to secure the systems used by CDA to provide CDAnet and ITRANS. A summary of the safeguards put in place by CDA is available upon request. CDA is not responsible for ensuring the security of any networks or systems at your Office or the security of any Claims Processor’s or any other Person’s networks or systems.

(b) In the provision of CDAnet and ITRANS to You, CDA has the right to take any corrective actions or steps related to CDAnet and ITRANS which CDA deems necessary to protect CDA’s technology infrastructure and CDA’s subscribers from actual or potential threats or security concerns. Such corrective actions or steps may include the suspension of the rights granted to You or any of your End Users to use CDAnet and ITRANS or the deletion of potentially malicious data.

3.6 Changes

(a) CDA may modify or upgrade the infrastructure that CDA uses to provide CDAnet and ITRANS, from time to time.

(b) CDA may change the CDAnet/Réseau ACDQ Standards from time to time, including any changes that are necessary to enable CDA to modify and improve CDAnet and ITRANS. Such changes may require You to update your systems to meet the new standards.

(c) CDA may change the features and functionality of CDAnet and ITRANS from time to time.

4. Support and Maintenance

4.1 CDA will provide reasonable service support through telephone and/or online chat Monday to Friday, 7:30 a.m. to 8:00 p.m. (local time in Ottawa, Ontario). Written instructions on the use of CDAnet and ITRANS will be posted to the PSS Website. Please note: If You are not using ITRANS: (i) CDA will not be able to check the status of specific Dental Benefit Claims in response to your request for support; and (ii) You will not be able to use the ITRANS tab of the PSS Website to view a record of all Dental Benefit Claims transmitted by your Office within the previous 60 days.

4.2 CDA will provide technical and administrative support in respect of CDAnet and ITRANS to You and End Users designated by You. CDA is not obligated to provide direct support to any other Person.

4.3 When possible, any maintenance of CDA's technology infrastructure will be conducted at the times set out below (the “Maintenance Window”):

Day of the Week Hours

Monday - Friday Between 6:00 p.m. and 2:00 a.m. (local time in Ottawa, ON)
Saturday - Sunday Between 6:00 a.m. and 10:00 p.m. (local time in Ottawa, ON)

5. Your Content

5.1 You acknowledge that CDA’s responsibility for Your Content is limited to processing it to provide You with CDAnet and ITRANS. In every other respect, You are responsible for Your Content. “Your Content” is defined in the Subscriber Agreement.

5.2 CDA will not be liable for the disclosure of Your Content or other information associated with your use of CDAnet and ITRANS if such disclosure is required by any law applicable in Canada, provided CDA, to the extent permitted by law, notifies You of any such requirement as soon as it is legally permitted to do so.

5.3 You are responsible for determining (on your behalf and on behalf of your End Users) the appropriateness of using CDAnet and ITRANS (with or without additional safeguards) in connection with the preparation, processing or transfer of Dental Benefit Claims, given the sensitivity of the information contained therein. In making any such decision, You will take into account all applicable laws, regulations and professional standards to which You are subject.

6. Personal Information and Personal Health Information

6.1 Information About You and Your Office

(a) For the purpose of providing You with CDAnet and ITRANS, it is necessary for CDA to collaborate with the Claims Processors and with the independent software vendors who provide CDA-certified practice management software. You authorize CDA to collect, retain, use, and disclose to the Claims Processors and the independent software vendors, your personal and professional information for purposes relating to the provision and administration of CDAnet and ITRANS and to enable the Claims Processors and independent software vendors to provide any products or services.

(b) Dental Benefit Claims identify one or more dentists and one or more Offices. This information is removed when copies of the Dental Benefit Claims are stored by CDA for the purpose of providing reporting related to the administration of CDAnet and ITRANS and analysis of overall dental benefit claims activity in Canada.

6.2 Patient Information

(a) You agree to obtain each patient’s consent to submit Dental Benefit Claims through CDAnet and if applicable ITRANS. A sample consent form may be found in the current CDAnet Dental Office User Guide found at www.cdanet.ca.

(b) You shall ensure that your End Users comply with the obligations set out in section 6.2(a).

(c) You agree to keep an original copy of each patient’s consent on file while the patient is active with the Office, and for a period of three years after the patient ceases to be active with the Office, or for the term stipulated by the registrar in the province of the Office, whichever is greater.

(d) You agree to provide copies of patient consents to CDA, or to a Claims Processor or their agent, upon request.

(e) The inclusion of Personal Information (relating to the applicable patient and plan member) in Dental Benefit Claims is necessary for processing. In accordance with section 3.3(b) of this Service Schedule, identifying information about patients and plan members is removed from those copies of the Dental Benefit Claims that are sent to CDA for purposes of enabling CDA to provide any support services relating to the transmission of Dental Benefit Claims. The removal of any such identifying information is carried out in accordance with general industry standards for the anonymization and/or aggregation of personal health information.

6.3 Concerns regarding privacy related to CDAnet and ITRANS described in this Service Schedule, and related generally to the Subscriber Agreement, may be directed to:

Canadian Dental Association
Attention: Chief Privacy Officer
1815 Alta Vista Drive
Ottawa, Ontario, Canada K1G 3Y6
privacy@cda-adc.ca

7. Disclaimer

7.1 Without limiting the generality of section 13 or section 14 of the Subscriber Agreement or any other provision of the Agreement limiting CDA's liability and even though CDA has designed and implemented CDAnet and ITRANS as secure services to be used by dental professionals, CDA cannot and does not provide any representation, warranty, condition or guarantee that:

(i) CDAnet and ITRANS will be uninterrupted or error free;

(ii) the measures which CDA has taken to preserve the integrity of any data created, transferred or maintained using CDAnet and ITRANS will always be effective; or

(iii) a Person cannot compromise the security measures which CDA has implemented in connection with CDAnet and ITRANS;

7.2 You further acknowledge that:

(i) the adjudication, processing, validation and/or payment of any Dental Benefit Claims is not the responsibility of CDA;

(ii) responding to any Dental Benefit Claims is not the responsibility of CDA; and

(iii) CDA is not responsible for any product or service obtained by You from any other Person for use by You in conjunction with your use of CDAnet and ITRANS.