Non-Insured Health Benefits (NIHB) Newsletter for Dental Providers - Fall
2002
News and Information for Our NIHB Providers
First Canadian Health
NIHB Toll-free Inquiry Centre: 1-888-471-1111
For our Dental Practitioners - Fall 2002
News and Views
Welcome to the fall 2002 edition of our quarterly newsletter. We are now in
our fourth year of operations as the claims processor for the NIHB Program
of the First Nations and Inuit Health Branch (FNIHB) of Health Canada.
Again, FCH would like to thank you for your support as you continue to provide
quality health services to First Nations and Inuit clients of the NIHB Program.
As always, your comments and questions are welcome. Please call our Toll-Free
Inquiry Centre Representatives at 1-888-471-1111, or send your correspondence
to:
FCH Provider Relations
3080 Yonge Street, Suite 3002
Toronto, ON M4N 3N1
New Warning Messages: W81 AND W82
You will notice the following warning messages on your NIHB Dental Claims
Statement for each line:
W81 - Client has provided consent
W82 - Client has not provided consent
You are not required to act upon these messages as they are for information
purposes only.
Threshold Increase
The threshold at which predetermination for basic services is required has
increased from $600 to $800 per 12 month period.
All codes indicated as 'P' in your NIHB Regional Dental Benefit
Grid continue to require predetermination regardless of the threshold.
All other predetermination guidelines remain unchanged.
Should you have any questions, please contact our Toll- Free Inquiry Centre
Representatives at 1-888-471-1111.
New NIHB Regional Dental Benefit Grid for General Practitioners, Specialists and Denturists
The new NIHB Regional Dental Benefit Grid for General Practitioners, Specialists
and Denturists for the following provinces are in effect as of the dates indicated
below:
August 1, 2002
September 1, 2002
- Yukon, GP/SP
- Manitoba, Denturist
- Ontario, GP/SP
- Ontario, Denturist
You should have received your new grid which reflects the change in prices.
Should you have any questions, please contact our Toll-Free Inquiry Centre
Representatives at 1-888-471-1111.
NIHB DENT-29 Form Used as a Claim
To ensure prompt payment of claims, please check the date printed in the bottom
left hand corner of any NIHB Dent-29 forms currently in your office. To prevent
unnecessary delays in claims processing and payment, please destroy any NIHB
Dent-29 forms dated prior to December 1998. Forms printed prior to December
1998 are not accepted by FCH and will be returned to you. Supplies of the new
NIHB Dent-29 forms can be requested from the FCH NIHB Toll Free Inquiry Centre
at 1-888-471- 1111.
Computer generated and standard dental claim forms may be submitted if all
data elements are present and a current NIHB Dent-29 form is attached. The
appropriate box: "For Post Approval", "For Predetermination" or "For
Claim" must be checked off on the NIHB Dent-29 form. Additionally, the "Signature
of Client (Parent/Guardian)" field must be completed on the NIHB Dent-29.
If it is a post approval, a predetermination or a claim for a new client, question
3B must be answered. (For further information please see DPIK section 6.)
Please ensure that your FCH provider number is included on all claims submissions.
Submission of Supporting Information with NIHB DENT-29 Form Used as a Claim
Dental practitioners are reminded that FCH does not require the submission
of any supporting documentation, with the exception of laboratory invoices
and Explanation of Benefits (EOB), for claim payment. Additional items included
with your claim are unnecessary.
However, supporting documentation such as study models, radiographs and photographs
should continue to be sent to the FNIHB Regional Office in your area, or to
the Orthodontic Review Centre, when appropriate, for predetermination and post
approval purposes.
Submission of Laboratory Invoices
Dental practitioners are reminded that laboratory invoices (original or photocopy)
must be attached to the NIHB Dent-29 claim form to be eligible for reimbursement.
NIHB Dent-29 forms with laboratory invoices that have been altered will be
returned to the dental practitioner with a Provider Return Letter.
Invoices for in -office lab fees must be submitted on the dental practitioner's
letterhead.
Should you have any questions, please contact our Toll- Free Inquiry Centre
Representatives at 1-888-471-1111.
NIHB NIHB Dental Claims Statement Corrections/Resubmissions
FCH has separate procedures for claim resubmissions (where the original has
not been processed by FCH) and for corrections to claims. Using the appropriate
procedure will assist in prompt claims payment.
When you have submitted an original claim for payment and have not received
payment or rejection of claim information for that claim on your NIHB Dental
Claims Statement you should resubmit the claim. To facilitate processing, all
NIHB Dent-29 claim form resubmissions must be clearly marked "RESUBMISSION" at
the top of the form. A photocopy of the original NIHB Dent-29 form for the
claim can be submitted. Original copies of claims are required except in the
case of claim resubmission.
When you have submitted an original claim for payment and need to make a claims
correction or adjustment, you do not need to send in a new claim. Doing so
will create unnecessary delays. The NIHB Dental Claims Statement should be
used to reconcile accounts. Corrections to claims should be indicated directly
below the existing information on the NIHB Dental Claims Statement and forwarded
to FCH within 60 days of the statement date for re-adjudication of the claim.
Please ensure that corrections made are clear and legible. Do not alter or
erase the existing information. If you are submitting a photocopy of your NIHB
Dental Claims Statement, please check that the photocopy is clear and complete.
NIHB DENT-29 Form Required Data Elements
Section 6 of the Dental Practitioner Information Kit contains a list of the
NIHB Dent-29 form required data elements.
Here are the common missing data elements that will result in the claim returned
to you unprocessed:
- client and provider address (including postal code);
- client identification information;
- stamped or signed office verification, and
- client signature.
Missing required data elements will result in the NIHB Dent-29 form being
returned to you unprocessed for correction.
Saskatchewan's Toll-free Number
Please note the toll-free number for providers calling the Saskatchewan Dental
Office from outside of the Regina area: 1-877-780-5458. The number for providers
calling from the Regina area is (306) 780-5458.
Attached are replacement pages for your NIHB Dental Practitioner Information
Kit (DPIK). Please remove the existing pages and insert the revised ones.
Published quarterly by First Canadian Health Management
Corporation Inc. at 3080 Yonge Street, Suite 3002, Toronto ON M4N 3N1
|
