Non-Insured Health Benefits (NIHB) Newsletter for Dental Providers - Fall
2003
News and Information for Our NIHB Providers
First Canadian Health
NIHB Toll-free Inquiry Centre: 1-888-471-1111
For our Dental Practitioners - Fall 2003
News and Views
Welcome to the fall 2003 edition of the Non-Insured Health Benefits (NIHB)
quarterly newsletter. First Canadian Health (FCH) is now in its fifth 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 contact the FCH
NIHB 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 NIHB Regional Dental Benefit Grid for General Practitioners and Specialists in Manitoba
The new NIHB Regional Dental Benefit Grid for General Practitioners and Specialists
in Manitoba will be in effect as of October 1, 2003.
The new grid reflects the change in prices and eligible procedures. Providers
should receive their grids shortly.
Should you have any questions, please contact the FCH NIHB Toll-Free Inquiry
Centre at 1-888-471-1111.
Date of Service on the NIHB DENT-29 Form
Providers are reminded to enter the date(s) of service in Part 1 of the NIHB
DENT-29 form using the format DD/MM/CCYY (e.g., enter July 21, 2001 as 21/07/2001).
When submitting a claim with one or more dates of service either place the
date beside each claim line or enter the date beside the first claim line and
draw an arrow or quotation marks below to indicate the same date of service.
This is to ensure that claims are processed accurately and not rejected due
to a missing or incorrect date.
For additional information, please refer to Section 6.2 of the NIHB Dental
Practitioner Information Kit (DPIK) which outlines the required data elements
on the NIHB DENT-29 form.
Reminder to Providers
The date for consent has been changed to March 1, & 2004. The W82 warning
message (CLIENT HAS NOT PROVIDED CONSENT) will continue to appear for each
paid claim line on the NIHB Dental Claim Statement as a reminder that the client
has not provided consent. Continue to provide services as usual during this
period.
For additional information on the consent initiative, providers must contact
the NIHB Consent Information Centre at 1-888-751-5011.
Submission of Claims for Services with a Predetermination/Pre-verification Number
Providers must record the predetermination/pre- verification number(s) in
the "PREDETERMINATION/ PRE-VERIFICATION NO." column in Part 1 of
the NIHB DENT-29 form when submitting a manual claim.
To ensure that each claim line is processed correctly, place the predetermination/pre-verification
number(s) beside each applicable claim line, or enter the
number beside the first claim line and draw an arrow or quotation marks below
to indicate which procedures apply to the same predetermination/pre-verification
number. The absence of such a reference will result in only the first claim
line being processed with the predetermination/ pre-verification number.
Providers are reminded to refer to the Predetermination Confirmation Letter
for details pertaining to the approval before submitting a claim for predetermined
services.
For additional information, please refer to Sections 5.2 and 5.3 of the NIHB
Dental Practitioner Information Kit (DPIK), which explain how to bill for services
with a predetermination/pre-verification number.
Copies of Communication Materials
Providers are reminded that claim submission and audit requirements are outlined
in the NIHB Dental Practitioner Information Kit as well as the quarterly NIHB
Dental Newsletter. It is important that your dental office retains the most
current documentation to ensure compliance with the audit process.
Providers may obtain an up-to-date practitioner kit and back issues of newsletters
through the NIHB website at:
www.hc-sc.gc.ca/fnihb-dgspni/fnihb/nihb
If you do not have Internet access, contact the FCH NIHB Toll-Free Inquiry
Centre at 1-888-471-1111.
Electronic Data InterchangeE (EDI) System for Real-time Processing
The implementation of an EDI system for real-time claim processing began in
Alberta on April 1, 2003 as part of a national roll-out. Real-time claim processing
will be gradually implemented in each region. Prior to regional implementation,
providers registered with CDAnet and meeting specific criteria, will be contacted
individually by FCH to make arrangements for real-time claim processing.
Should you have questions on this NIHB implementation, please contact the
FCH NIHB Toll-Free Inquiry Centre at 1-888-471-1111.
Updated NIHB Dental Practitioners Information Kit
The updated version of the NIHB Dental Practitioner Information Kit (DPIK)
is now available for printing on the NIHB website at the following URL address:
www.hc-sc.gc.ca/fnihb-dgspni/fnihb/nihb
Please replace your current copy of the NIHB DPIK with the updated version.
If you do not have Internet access, contact the FCH NIHB Toll-Free Inquiry
Centre at 1-888-471-1111.
Valid Client Identification Number for Recognized Inuit
Recognized Inuit accessing NIHB benefits anywhere in Canada can use their
NWT or Nunavut health care number as a valid client identification number.
For further information, please refer to Section 1.1.3 of the NIHB Dental
Practitioner Information Kit (DPIK).
Client Calls
Dental practitioners are requested to direct client inquiries to the appropriate
FNIHB Regional Office. Please refer to the Directory insert in the pocket of
your NIHB Dental Practitioner Information Kit (DPIK) for the telephone number
and address of each FNIHB Regional Office.
The FCH NIHB Toll-Free Inquiry Centre provides services to NIHB providers
only.
Address Correction for the Orthodontic Review Centre
The address for the Orthodontic Review Centre has been updated as follows:
Orthodontic Review Centre
Non-Insured Health Benefits
First Nations and Inuit Health Branch
Health Canada
Postal Locator 1919A
Tunney's Pasture
Ottawa, ON K1A 0L3
Providers should note that, for all orthodontic services processed by the
Orthodontic Review Centre, the address of the centre is now reflected on predetermination
confirmation letters.
Next Day Client Verification Program
The Next Day Client Verification Program is an ongoing process consisting
of a review of a sample of claims the day following receipt by FCH. The process
involves confirmation of the services provided to NIHB clients, and in some
instances, may result in claims being reversed or reversed and reprocessed
for a lower amount so that the payment is in line with the NIHB guidelines.
If providers receive a Dental Faxback Confirmation Form C, they must fax the
completed form back to the FCH Audit Department within 3 days, or mail within
2 weeks. The provider must confirm the information by signing the Dental Faxback
Confirmation Form C. Signature stamps are not accepted. If the faxback form
is not returned, the claim is automatically reversed.
If for any reason a provider cannot adhere to the timeline, the provider must
contact the FCH Audit Department to make alternate arrangements. The contact
information can be found on the Dental Faxback Confirmation Form C.
For additional information on the FCH Dental Provider Audit Program, please
refer to Section 8 of the NIHB Dental Practitioner Information Kit (DPIK).
Published quarterly by First Canadian Health Management Corporation Inc. at
3080 Yonge Street, Suite 3002, Toronto ON M4N 3N1
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