Non-Insured Health Benefits (NIHB) Newsletter for Dental Providers - Spring
2003
News and Information for Our NIHB Providers
First Canadian Health
NIHB Toll-free Inquiry Centre: 1-888-471-1111
For our Dental Practitioners
Spring 2003
News and Views
Welcome to the spring 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 Grids for General Practitioners and Specialists
The new NIHB Regional Dental Benefit Grid for General Practitioners and Specialists
for the following provinces will be in effect as of:
February 1, 2003
April 1, 2003
May 1, 2003
Providers in Saskatchewan should have received their new grid which reflects
the change in prices. Alberta and Quebec providers should be receiving their
grids shortly.
Should you have any questions, please contact the FCH NIHB Toll-Free Inquiry
Centre at 1-888-471-1111.
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.
Predetermination and Post Approval Submission to FNIHB
To ensure that predeterminations and post approvals are assessed promptly,
please submit NIHB DENT-29 forms requiring predetermination or post approval
to your FNIHB Regional Office or to the Orthodontic Review Centre when appropriate.
All predetermination and post approval requests received by FCH will be returned
to the provider with a letter indicating that "Predeterminations should
be forwarded to the appropriate Regional FNIHB Office (refer to DPIK Sub-Section
3.3)".
Electronic Data InterchangeE (EDI) System for Real-time Processing
The implementation of an EDI system for real time claim processing begins
in Alberta on April 1, 2003 as part of a national roll-out. Upon completion
of the Alberta phase, 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. In addition, these providers
will receive the updated NIHB Dental Practitioner Information Kit (DPIK) containing
real time claim processing procedures.
Should you have questions on this NIHB implementation, please contact the
FCH NIHB Toll-Free Inquiry Centre at 1-888-471-1111.
Coordination of Benefits (COB)
For those clients with provincial/territorial or private health insurance
plans, Coordination of Benefits (COB) for the NIHB Program will be based on
the Canadian Life and Health Insurance Association (CLHIA) guidelines.
Where a client has third party coverage, claim submissions are to be sent
first to the third party carrier. Once an Explanation of Benefits (EOB) is
received from the third party carrier, the EOB must be attached to a claim
and submitted to First Canadian Health (FCH) for COB and payment.
Pay Client Claims
If payment is to be made to the patient or a third party, please indicate
this by checking off the "Pay Client/Guardian" box on the NIHB DENT-29
claim form. Complete the "Payee Address" section only if the payee
name or address is different from the client's information. At no other time
should the "Payee Address" section be completed. If FCH receives
a claim that has an address entered in this section but does not have the "Pay
Client/Guardian" box checked, the claim form will be returned with a letter
indicating that the claim form is unclear. This is to ensure that payment is
made to the correct party.
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 on Predetermination Confirmation Letters for Yukon and Atlantic FNIHB Regional Offices
Following the address change of the Yukon and Atlantic FNIHB Regional Offices
indicated in the winter 2002-2003 newsletter, providers should note that the
updated addresses are now reflected on predetermination confirmation letters.
FNIHB Regional Office Address Change for Northwest Territories and Nunavut
To recognize Nunavut as a separate territory, the FNIHB Northwest Territories/Nunavut
Regional Office address has been updated.
Nunavut
FNIHB Nunavut
First Nations and Inuit Health Branch
Health Canada
14th Floor, Postal Locator 3914A
Sixty Queen Building
60 Queen Street
Ottawa ON K1A 0K9
Northwest Territories
FNIHB Northwest Territories
First Nations and Inuit Health Branch
Health Canada
14th Floor, Postal Locator 3914A
Sixty Queen Building
60 Queen Street
Ottawa ON K1A 0K9
These updates are reflected on the NIHB DENT-29 claim forms and the attached
April 2003 directory.
Providers should note that the updated address is also reflected on predetermination
confirmation letters.
Published quarterly by First Canadian Health Management
Corporation Inc. at 3080 Yonge Street, Suite 3002, Toronto ON M4N 3N1
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