Non-Insured Health Benefits (NIHB) Newsletter for Dental Providers - Summer
2002
News and Information for Our NIHB Providers
First Canadian Health
NIHB Toll-free Inquiry Centre: 1-888-471-1111
For our Dental Practitioners
Summer 2002
News and Views
Welcome to the summer 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,
First Canadian Health (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
Submission of Laboratory Invoices
Providers are reminded that laboratory invoices (original or photocopy) must
be attached to the NIHB Dent-29 form to be eligible for reimbursement. NIHB
Dent-29 forms with laboratory invoices that have been altered will be returned
to the practitioner with a Provider Return Letter.
Invoices for In -Office Lab charges must be submitted on the practitioner's letterhead.
Submission of Lab Fee on the NIHB DENT-29 Form
All procedure codes which are eligible for lab fees must be submitted with
a professional fee amount and a lab fee amount on the same claim line. If a
lab fee amount is not submitted for a lab eligible procedure code, the claim
line in question will be rejected with the R43 message, "LAB FEE MUST
BE SUBMITTED FOR SPECIFIED PROCEDURE CODE".
NIHB DENT-29 Form
The revised NIHB Dent-29 form has three check-boxes at the top of the form:
- FOR POST APPROVAL
- FOR PREDETERMINATION
- FORCLAIM
In Post Approval situations the NIHB Dent-29 form should be directed to the
appropriate FNIHB Regional Office for post treatment approval.
New NIHB Regional Dental Benefit Grid of General Practitionersm Specialists and Denturists
The new NIHB Regional Dental Benefit Grid for General Practitioners, Specialists
and Denturists for the following provinces will be in effect as of:
May 1, 2002
August 1, 2002
September 1, 2002
- Ontario, Denturist
- Ontario, GP/ SP
Should you have any questions, please contact our Toll-Free Inquiry Centre
Representatives at 1-888-471-1111.
NIHB Dental Provider Audit Program - Next-day Quality Assurance Program
The Next-Day Quality Assurance Program implemented in 2001 consists of a review
of a defined sample of claims submitted by providers the day following receipt
by FCH.
As part of the Next -Day Quality Assurance Program, you may receive a short
questionnaire by fax (or mail). The questionnaire (Faxback form) will ask that
specific treatment details for a NIHB client be completed on the form, and
faxed back (or mailed) to FCH.
These determinants are modified periodically over time, and other profile
patterns are incorporated into the Next -Day Quality Assurance Program. If
the information contained on the Faxback form indicates the inappropriate use
of a procedure code, or if the Faxback is not completed and returned by the
dental provider, claim reversals may be applied.
Dental Predetermination - Yukon Territory
Yukon Territory providers are reminded that dental services requiring predetermination
(with the exception of Orthodontic Predetermination - see article on "Predetermination
of Orthodontic Services") must now be obtained from the Northern
Secretariat at the following address:
Northern Secretariat
First Nations and Inuit Health Branch Health Canada
60 Queen Street 14th Floor, Address Locator 3914A
Ottawa ON K1P 5Y7
Tel.: 1-888-332-9222
Fax: 1-800-949-2718
Predetermination of Orthodontic Services
All predetermination requests for orthodontic services must be submitted to
the following address:
Orthodontic Review Centre
Non-Insured Health Benefits (NIHB)
First Nations & Inuit Health Branch (FNIHB)
Address Locator 1919A, Room 1913A
Tunney's Pasture
Ottawa ON K1A 0L3
Tel.: 1-866-227-0943
Fax: 1-866-227-0957
Orthodontic Incremental Payments
Providers submitting more than one claim with orthodontic
code P1300 (Incremental Orthodontic Payment) may receive a rejection message R48
(PREDETERMINATION FOR THIS ITEM HAS BEEN USED UP BY PREVIOUS CLAIM) even
though the predetermination has not been fully used up.
Procedure code P1300 must be claimed in full, as approved on the Predetermination
Confirmation Letter. Where incremental payments were approved, providers are
required to contact the Orthodontic Review Centre to obtain a new predetermination.
In the meantime, if you receive this rejection and determine that your incremental
orthodontic payment should have been paid, please contact our Toll-Free Inquiry
Centre Representatives at 1-888-471-1111.
Pre-verification of Dental Services
FCH is unable to issue a pre-verification number for dental procedure codes
that have already been pre-verified to another provider within the previous
6 months. A new pre -verification number can be issued once the original request
is used up or expires.
Predetermined Services - Same Date of Service
Claims submitted with the same date of service, procedure code and predetermination
number will result in the first claim line being paid and the remaining lines
being rejected with message R07 (THIS IS A DUPLICATE CLAIM.).
Should you provide multiple units of the same procedure code with the same
predetermination number on the same date of service, it is necessary to have
the predetermination amended to reflect the correct procedure code (e. g. 11112
+ 11112 = 11114) in order to receive payment for the full fees.
Predetermined Services with Co-ordination of Benefits
For services requiring predetermination and where co-ordination of benefits
with a primary carrier also applies, you are reminded to submit your full professional
fee (rather than the remaining balance after payment from the primary carrier)
for predetermination. The explanation of benefits (EOB) from the primary carrier
indicating the expected or paid amount must also be submitted.
Failure to do so may result in a reduction in the amount paid to the provider
as the Health Information Claims Processing System (HICPS) automatically calculates
the difference due.
Attached are replacement pages for your NIHB Dental Practitioner Information
Kit (DPIK). Please remove the existing pages and insert the revised ones.
Attached are replacement pages for your NIHB Pharmacy/ MS & E Provider
Information Kit (PPIK). 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
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