Non-Insured Health Benefits (NIHB) Newsletter for Dental Providers - Summer
2003
News and Information for Our NIHB Providers
First Canadian Health
NIHB Toll-free Inquiry Centre: 1-888-471-1111
For our Dental Practitioners
Summer 2003
News and Views
Welcome to the summer 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 of General Practitioners, Specialists, and Denturists
The new NIHB Regional Dental Benefit Grid for General Practitioners, Specialists
and Denturists for the following provinces and territories will be in effect
as of:
July 1, 2003
- Northwest Territories, GP
- Nunavut, GP
- Ontario, GP/SP
- Ontario, Denturist
The new grids reflect 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.
Client Consent Warning Message W82
The following warning message has been reintroduced and will be displayed
for each paid claim line on your NIHB Dental Claim Statement for clients who
have not provided consent:
W82 - Client has not provided consent
For additional information on the consent initiative, providers must contact
the NIHB Consent Information Centre at 1-888-751-5011.
2003 Procedure Code Changes
Dental providers are reminded that the only procedure codes that can be used
under the NIHB Program are the procedure codes currently published in the NIHB
Regional Dental Benefit Grids for Dentists and Denturists. The new procedure
codes (noted below in brackets) published in the 2003 suggested provincial/territorial
associations fee guides cannot be accommodated at this time.
Until further notice, for First Nations and Inuit clients receiving services
under the NIHB Dental Program:
- Dentists should continue to use the procedure codes identified in bold
in the following list:
13502 (14502), 13701 (16201), 43311 (16511), 43312 (16512), 43611 (14611),
43612 (14612), 43621 (14621), 43622 (14622), 43623 (14623), 43629 (43629),
43631 (14631), 43711 (14711), 43712 (14712), 43721 (14721), 43722 (14722),
43731 (14731), 43732 (14732), 43733 (14733), 43739 (14739), 43741 (14741),
43801 (14811), 43802 (14812), 43811 (14821), 43812 (14822), 43813 (14823),
43819 (14829)
- Denturists should continue to use the procedure codes identified in bold
in the following list:
32210 (32215), 32220 (32225), 32230 (32235), 32310 (32316), 32320 (32326),
32330 (32336), 33110 (33117), 33120 (33127), 33130 (33137), 42110 (42116),
42120 (42126), 42130 (42136), 42310 (42316), 42320 (42326), 42330 (42336),
43110 (43116), 43120 (43126), 43130 (43136)
Dental Provider On-site Audit Update
The Non-Insured Health Benefits (NIHB) Program, the Dental Regulatory Authorities
(DRA), the Canadian Dental Association (CDA) and the provincial dental associations
have reached an agreement on a protocol with respect to the Dental Provider
Audit Program of the NIHB Program.
The protocol has been developed to ensure that the following two objectives
are met:
- Health Canada's requirement to maintain accountability for the appropriate
expenditure of public funds; and
- The DRA's obligation to protect the public interest through the regulation
of the profession of dentistry.
The protocol consists of three options available to each DRA. The options
are as follows:
- Option A:
Referral to the Dental Regulatory Authority (DRA);
- Option B:
Dental Regulatory Authority/Health Canada Conjoint On-site Investigation/Audit;
and
- Option C:
Health Canada Administrative On-Site Audit.
The following list outlines the options selected by the provincial/territorial
DRAs:
- Option A:
Quebec, Ontario, Manitoba and Saskatchewan
- Option B:
Alberta
- Option C:
Newfoundland and Labrador, Nova Scotia, New Brunswick, Prince Edward Island,
British Columbia, Yukon, Northwest Territories and Nunavut
The option selected by each DRA has been implemented and an evaluation of
the effectiveness of the protocol will follow.
Coordination of Benefits (COB)
Where a client has third party coverage for a portion of their claim with
a provincial/territorial or private health care plan, all claim
submissions must first be sent 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 FCH for COB and payment.
For those clients with a third party coverage which covers a portion of their
claim, COB for the NIHB Program will be based on the Canadian Life and Health
Insurance Association (CLHIA) guidelines.
Electronic Data Interchange (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. 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, 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.
Published quarterly by First Canadian Health Management Corporation Inc. at
3080 Yonge Street, Suite 3002, Toronto ON M4N 3N1
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