Dental Adjudication Rules

Express Scripts Canada offers flexibility in the use of adjudication rules.

Customers can:

• Use Express Scripts Canada's standard set of claim-processing rules 
• Have designated users create their own customized rules in a user-friendly, Windows-based interface
• Use a combination of Express Scripts Canada and customized rules. Rules can be coded without the involvement of information systems staff

Rules can include:

• Age restrictions
• Frequency limitations
• Alternate benefit clause
• Fee-guide parameters

In all cases, the rules above can be applied at various levels, including the province, group or sub-group.