Non-Insured Health Benefits (NIHB) Newsletter for Dental Providers
- Fall 2004
News and Information for Our NIHB Providers
NIHB Toll-free Inquiry Centre: 1-888-471-1111
For our Dental Practitioners - Fall 2004
News and Views
Welcome to the fall 2004 edition of the Non-Insured Health Benefits
(NIHB) quarterly newsletter. First Canadian Health (FCH) is now in its
sixth 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 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, and for Denturists
The new NIHB Regional Dental Benefit Grids for General Practitioners
(GP) and Specialists (SP), and for Denturists (DT) will come into effect
for the following provinces on:
October 1, 2004
- New Brunswick, GP & SP
- New Brunswick, DT
- Newfoundland, GP & SP
- Newfoundland, DT
- Nova Scotia, GP & SP
- Nova Scotia, DT
- Prince Edward Island, GP & SP
- Prince Edward Island, DT
November 1, 2004
- Alberta, GP & SP
- Ontario, DT
The new grids reflect the change in prices and eligible procedures.
They will be sent to providers prior to the effective date.
Should you have any questions, please contact the FCH NIHB Toll-Free
Inquiry Centre at 1-888-471-1111 .
Protective Mouth Guard for Sports
Effective October 15, 2004, protective mouth guards for sports will
no longer be a funded benefit of the Non-Insured Health Benefits (NIHB)
Program. The decision to delist this service is consistent with all other
Non-Insured Health Benefit areas in that items used exclusively for sports
are not a funded benefit of the NIHB Program. The following procedure
codes will be end dated on the FCH system:
- 14501 (13501) - Protective Mouth Guard Appliance,Preformed
- 14502 (13502) - Protective Mouth Guard Appliance,Processed
- 13510 (Quebec GP) - Protective Athletic Appliance
- 12780 and 13520 (Quebec SP) - Mouth Guards
- 74010 (Denturist) - Mouth Guards
Next Day Claims Verification(NDCV) Program for Quebec Code 41300
Effective July 19, 2004, the NDCV program will review all claims submitted
for the desensitization code 41300 the day following receipt by FCH.
Since the code 41300 is only valid in Quebec, this process will only
be applied to claims submitted by providers registered in Quebec.
The Association des chirurgiens dentistes du Québec (ACDQ)
states that a maximum of $40.00 for desensitization is allowed per visit,
regardless of the number of teeth treated. Following the guideline set
by the ACDQ, all claims submitted for the desensitization code 41300
with the same date of service may be reversed, or reversed and reprocessed
for a lower amount, if the total amount paid for all claims exceeds $40.00.
Monies will be deducted from the provider's NIHB Dental Claim Statement as
a claim reversal.
For additional information on the FCH Dental Provider Audit Program,
please refer to Section 8 of the NIHB Dental Practitioner Information
Kit .
Electronic Data Interchange (EDI) System for Real-time
Processing
Electronic claim submission through EDI is available to CDAnet registered
providers in all provinces and territories for real-time claim processing.
Providers can register for EDI by contacting the FCH NIHB Toll-Free
Inquiry Centre at 1-888-471-1111 . To avoid registration
delays, providers must have the following information ready when calling:
- CDAnet Unique Number
- CDAnet Office Id
- Fax Number (if applicable)
- Name and version of the Software Vendor used
For further information on electronic claim submission through EDI,
please refer to your NIHB Dental Practitioner Information Kit .
Orthodontic Inquiries
All predetermination requests, correspondence and concerns regarding
orthodontics must be forwarded to the address below, not to the FNIHB
regional offices:
Orthodontic Review Centre
Non-Insured Health Benefits
First Nations and Inuit Health Branch
Postal Locator 1919A,
Tunney's Pasture
Ottawa, ON K1A 0L3
Phone: 1-866-227-0943
Fax: 1-866-227-0957
Providers can download a current version of the NIHB Dental Practitioner
Information Kit at the NIHB website:
www.hc-sc.gc.ca/fnihb-dgspni/fnihb/nihb
Providers without internet access can 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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