Non-Insured Health Benefits Newsletter
First Canadian Health
News and Information for Our NIHB Providers
NIHB Toll-Free Inquiry Centre: 1-888-511-4666
For our Pharmacy Providers
Winter 2002-2003
News and Views
Welcome to the winter 2002-2003 edition of our quarterly newsletter.
We are now in our fourth year of operations as the claims processor
for the NIHB Program of the First Nations and Inuit Health Branch
(FNIHB) of Health Canada.
Again, we 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
our Toll-Free Inquiry Centre Representatives at 1-888-511-4666,
or send your correspondence to:
FCH Provider Relations
3080 Yonge Street, Suite 3002
Toronto ON M4N 3N1
Winter 2002-2003 Updates to the NIHB Drug Benefit List (DBL)
Please find attached the winter 2002-2003 updates to the NIHB
Drug Benefit List (DBL). The update provides a list of all changes
to the April 1, 2002 NIHB DBL. It includes additions, replacement
DINs, limited use benefits, and drugs discontinued by the manufacturer
or removed from the Canadian market effective January 1, 2003.
The April 2002 NIHB DBL as well as the updates can be downloaded
online at the following Internet address:
www.hc-sc.gc.ca/fnihb/nihb/pharmacy/drugbenefitlist
Should you have any questions, please contact the FCH NIHB Toll-Free
Inquiry Centre's customer service representatives at 1-888-511-4666.
Claims Over One Year Old
Providers have one year from the date of service to secure payment.
Claims submitted more than one year after the date of service will
be rejected with the R21 message (PERIOD FOR SUBMITTING CLAIMS
HAS EXPIRED).
Submission of Claims for Clients of Band #047 Miawpukek (Formerly Known as Conne River)
On November 1, 2002, FCH commenced processing NIHB pharmacy claims
for all clients from Band #047 Miawpukek (formerly known as Conne
River).
Claims with a date of service on or after November 1, 2002, for
all Band #047 clients may be submitted to FCH for payment. Manual
claims should be sent to the following address:
FCH, NIHB Claims Dept.
5770 Hurontario St., 10th Floor
Mississauga, Ontario
L5R 3G5
Claims with a date of service prior to November 1, 2002 for all
Band #047 clients must be sent to the following address for payment:
Conne River Health and Social Services
Attn Linda Joe, Administrative Assistant
P.O. Box 160, Conne River Reserve
Newfoundland A0H 1J0
Tel.: (709) 882-2710, Extension 5103
Contact for System Problems
Providers should contact the FCH NIHB Toll-Free Inquiry Centre
at 1-888-511-4666 regarding system interruptions,
slow response times, and host time-outs.
Please do not contact FNIHB Regional Offices regarding system
problems.
Provider Change of Address
Providers are required to inform FCH when they have a change of
address. Failure to do so may result in a delay in receiving payment
and will delay reception of bi-monthly statements and quarterly
newsletters.
Reminder for Quebec Providers
Quebec providers are reminded that all pharmaceutical items need
to be prescribed by a medical doctor, dentist, or any other person
authorized by Quebec provincial law to prescribe. The prescription
must also specify the course of the treatment. In addition, the
NIHB Program reserves the right to reject payment of a transaction
for refills of prescriptions more than one year after date of issue.
For eligible medical supplies and equipment (MS&E), other
than supplies for diabetics, as well as urine and blood testing
agents, please note that a prior approval from FNIHB Regional Office
may be required. Also, Health Canada has the right to request the
appropriate documentation to justify any amount claimed which must
correspond to the manufacturers' acquisition cost and a maximum
of a 30% mark-up.
Pharmacists filling or repeating a drug prescription for a chronic
or long-term illness and dispensing medication for a treatment
period of less than 28 days, in the form of a dosette, to a client
unable to manage his/her medication independently, the fee to be
billed is $4.00 as specified in point 11, article 6.2 of the agreement
between Health Canada and the Association québécoise
des pharmaciens propriétaires (AQPP).
In assessing the need to provide a dosette, pharmacists must determine
that the patient is unable to manage his/her medication independently,
either because of a cognitive impairment or a physical disability.
Examples of factors which would confirm such impairment include:
- Early or tardy renewal of prescriptions
- Regular forgetfulness or delay in taking required dosage
- Lack of understanding of the goals or methods of drug therapy
- Repeated therapeutic failure
- Complex dosage plan
The reasons for providing a dosette must be recorded in the patient's
file.
For more information, please contact FNIHB Regional Office in
Quebec at 514-283-1575 (from the Montreal area)
or 1-877-483-1575 (from outside of Montreal).
FNIHB Regional Office Addresses Changes
Atlantic
The address of the Atlantic FNIHB Regional Office has been changed.
The address is as follows:
First Nations and Inuit Health Branch
Health Canada
Maritime Centre
Suite 1525, 15th Floor
1505 Barrington Street
Halifax, NS B3J 3Y6
Yukon, NWT and Nunavut
The postal code of the address for the Yukon, NWT and Nunavut
FNIHB Regional Office at the Northern Secretariat has been changed.
The address is as follows:
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 on the attached directory for insertion into
the NIHB Pharmacy/MS&E Provider Information Kit.
Providers should note, however, that the updated address
will not be on PA confirmation letters until April 2003.
Published quarterly by First Canadian Health
Management Corporation Inc. at 3080 Yonge Street, Suite 3002, Toronto
ON M4N 3N1
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