Topics Client Identification Dental Information Drug/Pharmacy Information Medical Supplies & Equipment Information Resources & Forms

Get NIHB's RSS Feeds

Resources and Forms

This section contains contact information for provider inquiries, as well as forms and information products such as: sample forms; descriptions of reports, publications and other useful information products.

Provider Inquiries

Health Canada:

• For general information about the First Nations and Inuit Non-Insured Health Benefits (NIHB) program and services, contact the Non-Insured Health Benefits Directorate.
  
  
• For provider information about NIHB client and benefit eligibility, client reimbursement and appeal procedures, contact your Non-Insured Health Benefits Regional Office.
  
  
• Pharmacy providers requesting prior approval of drug benefits may contact the NIHB Drug Exception Centre.
  
  
• Dental or Medical Supplies and Equipment providers requesting predeterminations and prior approvals may call their respective NIHB Prior Approval and Predetermination toll-free lines.

First Canadian Health:

First Canadian Health (FCH) is contracted to administer Health Information and Claims Processing Services for dental, medical supplies and equipment (MS&E) and pharmacy benefits on behalf of Health Canada. All NIHB providers submit claims for payment to FCH for NIHB dental, MS&E and pharmacy services/benefits provided to First Nations and Inuit clients.

• General Information
  Providers with general information requests should direct their written inquiries to:
  First Canadian Health
  Non-Insured Health Benefits Provider Relations Department
  3080 Yonge Street, Suite 3002
  Toronto, Ontario
  M4N 3N1
  
  

• NIHB Toll-Free Inquiry Centres

  • NIHB Dental and MS&E Toll-Free Inquiry Centre: 1-888-471-1111
    Dental and MS&E Providers may contact FCH at this toll-free number for general information, client eligibility, benefit eligibility, and billing and payment information. Important: Please have your Provider ID Number ready when calling.

  • NIHB Pharmacy Toll-Free Inquiry Centre: 1-888-511-4666
    Pharmacy Providers may contact FCH at this toll-free number for general information, client eligibility, benefit eligibility, and billing and payment information. Important: Please have your Provider ID Number ready when calling.
    

• Audit Program
  All NIHB providers requiring additional information about the FCH /NIHB Provider Audit Program may contact the FCH Director of Provider Audit in writing by fax at 1-888-276-9848.
  
  
• Verification of client eligibility
  All NIHB providers may verify client eligibility in advance of providing services by contacting the appropriate NIHB Toll-Free Inquiry Centre.
  

  In order to verify client eligibility, the FCH Customer Service Representative (CSR) will require the provider identification number, the client's surname, given names, date of birth, and client identification number.
  
  If the CSR cannot verify the client, the client should be referred to for:

  • Eligible First Nations clients, their Band Office or the Registration Services Unit of Indian and Northern Affairs Canada (INAC) at (819) 953-0960;
  • Inuit residing in the Northwest Territories and Nunavut, their respective territorial Department of Health and Social Services; and
  • Inuit residing outside of the Northwest Territories and Nunavut, the nearest FNIHB Regional Office.

Forms and Information Products

Dental Benefits
Drug Benefits
Eye and Vision Care Benefits
Medical Supplies and Equipment Benefits
Medical Transportation Benefits

RSS Feeds:
Sign up for the Non-Insured Health Benefits Program Really Simple Syndication (RSS) feeds to receive updated information delivered directly to you.

Some of the following hyperlinks are to sites of organizations or other entities that are not subject to the Official Languages Act. The material found there is therefore in the language(s) used by the sites in question.

Dental

When requesting funding for dental benefits to the Non-Insured Health Benefits (NIHB) Program, providers may use one of the following forms depending on the services required.

• NIHB DENT-29 Form
  To request predetermination, submit a claim or a client reimbursement request, use the NIHB DENT-29 Form

• Standard Dental Claim Form
  The Standard Dental Claim Form can also be used for predetermination or to submit a claim request. This form is available from the Canadian Dental Association (CDA).

• ACDQ Dental Claim and Treatment Plan Form - Association des chirurgiens dentistes du Québec
  To request a predetermination or submit a claim request in Quebec, use the ACDQ Dental Claim and Treatment Plan Form which is available from the Association des chirurgiens dentistes du Québec.

• Orthodontic Summary Sheet
  In addition to the NIHB DENT-29 Form, providers should complete the NIHB Orthodontic Summary Sheet when requesting funding for orthodontic treatment.

• Completion of Active Orthodontic Treatment Form
  Once the orthodontic treatment is completed, use the NIHB Completion of Active Orthodontic Treatment Form to request final payment.

• Client Reimbursement Request Form
  To submit a reimbursement request to the NIHB Program, use the NIHB Client Reimbursement Request Form.

• NIHB Dental Claim Statement
  The Non-Insured Health Benefits Dental Claim statement is sent with any claims payment cheques or electronic funds transfer notices. It provides information about each manual or electronic claim processed.
  View the Sample Dental Claim Statement.

• Predetermination Confirmation Letter
  The Predetermination Confirmation Letter is issued to dental providers once predetermination services have been approved.
  Sample Predetermination Confirmation Letter.

• Dental and Orthodontic Bulletins
  The Non-Insured Health Benefits Dental and Orthodontic Bulletins are published as required to inform providers of updates regarding the provision of dental benefits to eligible recipients.

• Dental Policies
  The Non-Insured Health Benefits Dental Policies clearly define the clinical criteria and guidelines under which the NIHB Program will fund dental services for eligible registered First Nations and recognized Inuit.

• Dental Policy Framework The Non-Insured Health Benefits Dental Policy Framework clearly defines the terms and conditions, policies and benefits under which the NIHB Program will fund dental services for eligible registered First nations and recognized Inuit.

• Newsletters for Dental Providers
  The Non-Insured Health Benefits Newsletter for Dental Providers is published quarterly and contains important news and information for dental providers who provide services to NIHB recipients.

• NIHB Regional Dental Benefit Grid
  For a complete list of eligible benefits, benefits with frequency limitations and services requiring predetermination, dental providers must see the current NIHB Regional Dental Benefit Grid. To obtain a copy, providers must call the NIHB Toll-Free Inquiry Centre.

• Orthodontic Benefits - Questions and Answers
  The Non-Insured Health Benefits Program has developed a series of frequently asked questions for dental providers to provide additional information regarding Orthodontic benefits.

• Questions and Answers - October 2005 Changes to Dental Benefits Requiring Prior Approval and the new Dental Policy Framework

• Questions and Answers - July 2005 Dental Benefits Changes

Drug/Pharmacy

• Modifications to Pharmacy/MS&E Provider Information Form
  FCH requires certain information about each participating Pharmacy Provider to properly identify and pay the Pharmacy Provider for claims adjudicated by FCH. This form should be accompanied by the signed Pharmacy/MS&E Provider Agreement. View the Sample Modifications to Pharmacy/MS&E Information form.

• Non-Insured Health Benefits Pharmacy Claim Form
  The Non-Insured Health Benefits Pharmacy Claim Form is used to submit claims request for pharmacy benefit items.
  View the Sample Pharmacy Claim Form.

• Client Reimbursement Request Form
  To submit a client reimbursement request to the NIHB Program, use the NIHB Client Reimbursement Request Form.

• NIHB Pharmacy Claim Statement
  Twice per month, the Non-Insured Health Benefits Pharmacy Claim Statement is issued to providers, summarizing submitted and entered claims settled during the period.
  View the Sample Pharmacy Claim Statement.

• Drug Benefit List
  The Non-Insured Health Benefits Drug Benefit List a listing of the drugs provided as a benefit by the NIHB Program. The list is published once a year in April, with updates generally every three months.

• Drug Bulletins
  The Non-Insured Health Benefits Drug Bulletin is published as required to inform providers of updates regarding the provision of drug benefits to eligible recipients.
  The drug bulletins include deletions and additions to the Drug Benefit List, as well as changes in benefit status, the maximum allowable quantities for narcotic combination products, and frequency limits.

• Drug Use Evaluation Bulletins
  The Drug Use Evaluation (DUE) bulletin is published as needed to provide information on the findings and recommendations from the Drug Use Evaluation Advisory Committee to the NIHB Program.

• Newsletters for Pharmacy Providers
  The Non-Insured Health Benefits Newsletter for Pharmacy Providers is published quarterly and contains important news and information for pharmacy providers who provide services to NIHB recipients.

Eye and Vision Care Benefits

• NIHB Eye and Vision Products and Services Prior Approval and Claims Form
  When requesting funding for vision care benefits to the Non-Insured Health Benefits (NIHB) Program, providers may use the NIHB Eye and Vision Products and Services Prior Approval and Claims Form.
  
  The form information is available in HTML and Portable Document Format (PDF). The HTML version of the NIHB Eye and Vision Products and Services Prior Approval and Claims Form is not an actual form. It displays the information found on the form for viewing purposes only and will not be accepted if used to request funding.
  
  
  Providers wishing to submit a form must use only the PDF version of the NIHB Eye and Vision Products and Services Prior Approval and Claims Form. The form may also be used to submit a reimbursement request.

• Vision Care Framework
  The Non-Insured Health Benefits Vision Care Framework clearly defines the benefits and criteria associated with the provision of vision care benefits to NIHB recipients.

Medical Supplies and Equipment

When requesting funding for medical supplies and equipment benefits to the Non-Insured Health Benefits (NIHB) Program, providers may use any of the following forms.

• Changing Provider Information
  Medical Supplies and Equipment (MS&E) providers wishing to change any of the provider information communicated upon registration may use the Modifications to Pharmacy/MS&E Provider Information form.
  View the Sample Modifications to Pharmacy/MS&E Information form.

• Medical Supplies and Equipment Claim Form
  The Medical Supplies and Equipment Claim Form is used to submit a claim or for a re-submission.
  View the Sample Medical Supplies and Equipment Claim Form.

• Client Reimbursement Request Form
  To submit a client reimbursement request to the NIHB Program, use the NIHB Client Reimbursement Request Form.

• Medical Supplies and Equipment Claim Statement
  Twice per month, the Medical Supplies and Equipment Claim Statement is issued to providers. It summarizes submitted and entered claims settled during the period. See the Sample Medical Supplies and Equipment Claim Statement.

• Medical Supplies and Equipment Prior Approval Confirmation Letter
  The Medical Supplies and Equipment Prior Approval Confirmation Letter is issued by to providers after the approval process for specific MS&E items is complete. The confirmation letter includes applicable dates and prior approval details.
  View the Sample Medical Supplies and Equipment Prior Approval Confirmation Letter.

• Medical Supplies and Equipment Bulletins
  The NIHB Medical Supplies and Equipment Bulletins are published as required to inform providers of updates regarding the provision of medical supplies and equipment benefits to eligible recipients.

• Newsletters for Medical Supplies and Equipment Providers
  The NIHB Newsletters for Medical Supplies and Equipment Providers are published quarterly and contain important news and information for medical supplies and equipment providers who provide services to NIHB recipients.

Medical Transportation Benefits

• Medical Transportation Bulletins
  The Non-Insured Health Benefits Medical Transportation Bulletins are published as required to inform providers of updates regarding the provision of transportation benefits to eligible recipients.
  
  
• Medical Transportation Policy Framework
  The Non-Insured Health Benefits Medical Transportation Policy Framework outlines the policies and benefits that help recipients access medical services, the types of medical travel eligible for coverage and the benefits provided.