Non-Insured Health Benefits (NIHB) Newsletter for Dental Providers - Spring
2004
News and Information for Our NIHB Providers
First Canadian Health
NIHB Toll-free Inquiry Centre: 1-888-471-1111
For our Dental Practitioners - Spring 2004
News and Views
Welcome to the spring 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
The new NIHB Regional Dental Benefit Grid for General Practitioners
(GP) and Specialists (SP) for the following provinces and territories will
be in effect as of:
April 1, 2004
May 1, 2004
June 1, 2004
- Alberta, GP & SP
- British Columbia, GP & SP
Thenew grids reflect the change in prices and eligible procedures. They will
be sent to providers once available.
Should you have any questions, please contact the FCH NIHB
Toll-Free Inquiry Centre at 1-888-471-1111.
New Approach to the NIHB Program's Consent Initiative
On February 4, 2004, Health Canada announced a new approach to the NIHB Program's
Consent Initiative. The new approach means that the March 1, 2004, deadline
for the submission of consent forms by NIHB First Nations andInuit clients
no longer applies. Under this new approach, the NIHB Program will not require
a signed consent form for day-to-day processing activities and program administration.
NIHB clients will therefore continue to receive benefits for which they are
eligible even if they have not signed a consent form.
Health Canada would like to express its appreciation to those
providers who assisted in, and supported, the NIHB Program's Consent Initiative.
For more details on the new approach to the initiative, please visit Health
Canada's website at the following URL address:
www.hc-sc.gc.ca/fnihb/nihb/consent/urgent_noticefeb.htm
Providers may also contact the NIHB Consent Information Centre at 1-888-751-5011.
Consent Warning Message: W82
Providers will continue to receivethe warning message W82 (Client
has not provided consent) on paid claims for clients who have not
provided consent.
Providers are asked to disregard this warning message as the March
1, 2004 deadline no longer applies.
Questions regarding the W82 warning message can be directed to the FCH NIHB
Toll-Free Inquiry Centre at 1-888-471-1111.
Requirement for Client Signature on the NIHB DENT-29 Claim Form
It has been noted that "Signature on File" is being submitted for
clients where an original signature is required. As of July 1, 2004, if "Signature
on File" is used where the original signature is required, the NIHB DENT-29
form will be returned to you.
The NIHB policy for client signature states that the signature of the client,
parent, or guardian is mandatory for all claims, and must be on the NIHB DENT-29
claim form. If the client signature field is not completed, the claim will
be returned to the provider.
In the case of children who attend subsequent dental appointments without
a parent or guardian, "Signature on File" must appear in the "Signature
of Client (Parent/Guardian)" field on the NIHB DENT-29 claim form, and
a signed NIHB DENT-29 form must be retained in the patient's chart. This is
an important policy from the point of view of provider liability and program
audit requirements.
Band #458 -- Bigstone Cree Nation
The Bigstone Health Commission assumed complete management of dental benefits
on behalf of the members of Bigstone Cree Nation (Band #458) on February 1,
2004. This means that claims and predeterminations with a date of service (DOS)
on or after April 1, 2003, must be submitted to Bigstone Health Commission.
Claims submitted to FCH with a DOS on or after April 1, 2003, will be rejected
with the message R30 (Client has alternative coverage. Contact FNIHB).
Claims with a DOS prior to April 1, 2003 must be submitted to FCH and will
be processed as usual. Predeterminations with a DOS prior to April 1, 2003
must be sent to FNIHB.
Bigstone Health Commission's contact information is:
Attn: Mabel Gladue Bigstone Health Commission P.O. Box 1590 Wabasca,AB T0G
2K0
Phone: (780) 891-4161
Toll Free: 1-866-891-9719
Fax:(780) 891-3222
Next Day Claim Verification Program
The Next Day Claim Verification Program is an ongoing process consisting of
a review of a sample of claims the day following receipt by FCH. Audits are
conducted to confirm that claims are being properly processed and documented.
This process 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.
Monies will be deducted from your NIHB Dental Claim Statement.
Providers may receive a Dental Faxback Confirmation Form C asking
them to describe the clinical circumstances and services provided on the date
of service noted on the form. Providers must complete the form and return it
within 2 weeks from the date of receipt. If the form is not returned within
2 weeks, the claim is reversed.
Forms returned within the timeframe indicated will be evaluated by the audit
team to determine if the information provided is consistent with the procedure
codes claimed. Any inconsistencies or lack of information will result in the
claim being reversed. Procedure codes and defined code descriptions are not
accepted as a sufficient response. Claims with predeterminations or pre-verifications
are also subject to this process.
For additional information on the FCH Dental Provider Audit Program, please
refer to Section 8 of the NIHB Dental Practitioner Information Kit.
First Canadian Health and First Nations and Inuit Health Branch Roles
First Canadian Health is responsible for claims processing and
to answer inquiries from providers regarding:
- Client eligibility
- Benefit eligibility
- Pre-verification numbers
- Payment information
- Provider registration and provider file updates
- Distribution of NIHB Regional Dental Benefit Grids
Providers should call the FCH NIHB Toll-Free Inquiry Centre at 1-888-471-1111 if
they have any questions regarding the above.
First Nations and Inuit Health Branch Regional Offices are responsible for:
- Predetermination requests and amendments
- Inquiries from NIHB clients regarding benefits and eligibility
- Reimbursement requests from NIHB clients for prepaid services
Please refer to the Directory insert in the pocket of your NIHB Dental
Practitioner Information Kit for the telephone number and address of
each FNIHB Regional Office.
For further information on FNIHB and FCH responsibilities, please refer to
Sections 2.9 and 9 of your NIHB Dental Practitioner Information Kit.
Claims sent to the Previous NIHB Claims Processor in Error
Claims are still being sent to the previous NIHB claims processor by some
providers. All claims must be sent to First Canadian Health; the current NIHB
claims processor:
First Canadian Health
Claims Processing Department
3080 Yonge Street, Suite 3002
Toronto ON M4N 3N1
The only exceptions to this requirement are claims for members of bands who
have assumed responsibility for the administration of their NIHB benefits (e.g.,
Bigstone Cree Nation). Information regarding these exceptions is communicated
to providers through the NIHB Newsletter.
Published quarterly by First Canadian Health Management
Corporation Inc. at 3080 Yonge Street, Suite 3002, Toronto ON M4N 3N1
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