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
Fall 2003
News and Views
Welcome to the fall 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 1-888-511-4666,
or send your correspondence to:
FCH Provider Relations
3080 Yonge Street, Suite 3002
Toronto, ON M4N 3N1
Fall 2003 NIHB Drug Benefit List Update
Please find attached the fall 2003 updates, which list all changes
to the April 1, 2003 NIHB Drug Benefit List (DBL). These updates
include the addition/replacement of DINs, limited use benefits,
drugs removed from the Canadian market and drugs discontinued by
the manufacturer effective October 1, 2003.
These updates are reflected in the most recent electronic version
of the NIHB DBL. Please refer to the website at the following URL
address:
www.hc-sc.gc.ca/fnihb/nihb/pharmacy
Changes to the NIHB MS&E Benefit List
The NIHB Program has updated the NIHB MS&E Benefit List and
the Pharmacy/MS&E Provider Information Kit (PPIK). New codes
have been created, some existing codes have been renamed and obsolete
codes have been deleted. Certain benefit codes have had changes
to the frequency and/or prior approval requirements.
These changes take effect on November 1, 2003. It
is essential that all NIHB pharmacy providers download an up-to-date
version of the NIHB PPIK from the NIHB website (see URL address
at the end of this article) in order to facilitate proper billing.
The changes are highlighted in the updated Section 10 of the
NIHB PPIK.
The following are new codes:
99400398, 99400800, 99400801, 99400802, 99400803, 99400804, 99400805,
99400806, 99400809, 99400810, 99400811, 99400812, 99400813, 99400814,
99400816, 99400817, 99400818, 99400819, 99400820, 99400821, 99400822
There have been changes to the following codes:
99400004, 99400045, 99400046, 99400049, 99400050, 99400051, 99400052,
99400103, 99400105, 99400107, 99400108, 99400109, 99400110, 99400111,
99400113, 99400119, 99400120, 99400121, 99400122, 99400128, 99400129,
99400130, 99400131, 99400136, 99400137, 99400138, 99400139, 99400160,
99400161, 99400177, 99400181, 99400182, 99400185, 99400206, 99400215,
99400236, 99400241, 99400242, 99400260, 99400261, 99400266, 99400267,
99400310, 99400318, 99400320, 99400326, 99400352, 99400354, 99400355,
99400356, 99400362, 99400365, 99400366, 99400371, 99400399, 99400404,
99400405, 99400407, 99400409, 99400410, 99400411, 99400414, 99400415,
99400422, 99400432, 99400436, 99400437, 99400440, 99400441, 99400446,
99400448, 99400449, 99400450, 99400451, 99400453, 99400454, 99400456,
99400461, 99400462, 99400463, 99400546, 99400547, 99400568, 99400630,
99400648, 99400698, 99400699, 99400727, 99400730, 99400731, 99400732,
99400733, 99400734, 99400735, 99400736, 99400740, 99400741, 99400742,
99400743, 99400744, 99400745, 99400746, 9 9400749, 99400750, 99400751,
99400752, 99400753, 99400758, 99400761, 99400762, 99400783, 99400784
Additional information regarding the funding of the Continuous
Positive Airway Pressure (CPAP) unit and reminders to providers
for orthothic/prosthetic, custom- made footwear and audiology are
available in the September 2003 NIHB MS&E Bulletin.
An updated version of the NIHB PPIK will be available in mid-October
2003 on the Health Canada website at the following URL address:
www.hc-sc.gc.ca/fnihb-dgspni/fnihb/nihb
Replace your entire NIHB PPIK with the updated version. If you
do not have Internet access, contact the FCH NIHB Toll-Free Inquiry
Centre at 1-888-511-4666.
Reminder to Providers
The date for consent has been changed to March 1, 2004. The CPhA
code HH and the W82 warning message (CLIENT HAS NOT PROVIDED CONSENT)
will continue to appear for each paid claim line as a reminder
that the client has not provided consent. Continue to provide services
as usual during this period.
For additional information on the consent initiative, providers
must contact the NIHB Consent Information Centre at 1-888-751-5011.
Coordination of Benefits with Ontario Drug Benefit Limited Use Drug Products (For Ontario Pharmacies Only)
Ontario pharmacists must pursue payment through ODB prior to billing
the NIHB Program for drugs listed on the Ontario Drug Benefit (ODB)
Limited Use (LU) Drug Products list. It may be necessary to contact
the prescriber to have the prescription written on the ODB LU prescription
form. Results of the ODB limited use request must be documented
and kept on file in the NIHB client's profile for review during
on-site audit.
Claims for items on the ODB list (including the limited use section)
not coordinated with ODB prior to billing the NIHB Program will
now be rejected with the message R08 (PATIENT OVER 65 -
SUBMIT CLAIM TO ONT DRUG BENEFIT).
For further information, refer to Section 4 of the NIHB Pharmacy/MS&E
Provider Information Kit, which explains the requirements for coordination
of benefits.
Methadone for Opioid Dependancy, Pseudo-DIN 00908835
Effective October 1, 2003, a new policy will be put in place for
the submission and the reimbursement of methadone used for the treatment
of addictions for all provinces and territories, excluding Quebec.
Methadone claims must be submitted by using the pseudo-DIN
00908835. Claims submitted with another pseudo-DIN will
be subject to reclaim.
The provider will no longer have to contact the National
Drug Exception Centre to obtain a special authorization,
before submitting claims for methadone.
Claims must be submitted once a week (every seven days)
at the end of the week. In Ontario, due to legislation,
claims will continue to be submitted daily.
Cost of the Drug: The drug cost submitted will
be the actual acquisition cost (AAC). The drug cost submitted will
reflect the number of milligrams dispensed as
opposed to the volume dispensed. Where applicable, the mark-up
(MU) submitted will be in accordance with the NIHB Program Pharmacy
Pricing Guidelines defined by region.
Dispensing Fee (DF): The DF, submitted at the
end of the week, will be a weekly fee calculated
as follows: Day one: 1.5 times the current DF + an "interaction
fee" of $3.50. From day 2 to day 7, only the $3.50
interaction fee will be reimbursed.
The interaction fee will be reimbursed for each dose that the
pharmacist witnesses. For doses that the patient carries home,
the interaction fee shall not be claimed.
In summary, the total claim submitted weekly (every seven days)
will be the total of the drug cost + the MU (where applicable)
+ DF. In Ontario, the total weekly amount will be divided by seven
and submitted daily.
Note: For treatment using methadone for other
indications, please refer to the NIHB Drug Bulletin dated January
2002.
Valid Client Identification Number for Recognized Inuit
Recognized Inuit accessing NIHB benefits anywhere in Canada can
use their NWT or Nunavut health care number as a valid client identification
number.
For further information, please refer to Section 1.3 of the NIHB
Pharmacy/MS&E Provider Information Kit (PPIK).
Copies of Communication materials
Providers are reminded that claim submission and audit requirements
are outlined in the NIHB Pharmacy/MS&E Provider Information
Kit (PPIK) as well as the quarterly NIHB Pharmacy Newsletter. It
is important that your office retains the most current documentation
to ensure compliance with the audit process.
Providers may obtain an up-to-date provider kit and back issues
of newsletters through the NIHB website at:
www.hc-sc.gc.ca/fnihb-dgspni/fnihb/nihb
If you do not have Internet access, contact the FCH NIHB Toll-Free
Inquiry Centre at 1-888-511-4666.
Client Calls
Pharmacy providers are requested to direct client inquiries to
the appropriate FNIHB Regional Office. Please refer to the Directory
insert in the pocket of your NIHB Pharmacy/MS&E Provider Information
Kit (PPIK) for the telephone number and address of each FNIHB Regional
Office.
The FCH NIHB Toll-Free Inquiry Centre provides services to NIHB
providers only.
Quebec MS&E New Fax Number
The FNIHB Quebec Regional Office has a new fax number for all
MS&E prior approval requests. The new fax number is (514)
283-SSNA (7762).
Published quarterly by First Canadian Health Management Corporation
Inc. at 3080 Yonge Street, Suite 3002, Toronto ON M4N 3N1
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