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
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 1-888-511-4666,
or send your correspondence to:
FCH Provider Relations
3080 Yonge Street, Suite 3002
Toronto, ON M4N 3N1
Summer 2003 NIHB Drug Benefit List Update
Please find attached the summer 2003 updates which list all changes
to the April 1, 2003 NIHB DBL. These updates include addition/replacement
of DINs, limited use benefits, drugs removed from the Canadian
market and discontinued drugs effective July 1, 2003.
These updates are reflected in the electronic version of the NIHB
DBL dated July 1, 2003. Please refer to the website at the following
URL address: www.hc-sc.gc.ca/fnihb/nihb/pharmacy/drugbenefitlist/
Methadone for Opioid Dependancy, Pseudo-DIN 00908835
Pseudo-DIN 00908835 must be used when submitting a claim for methadone
that is compounded for the treatment of opiate dependency. Providers
are reminded that a special authorization from the NIHB Drug Exception
Centre (DEC) is required.
Required Docuimentation for Prescriptions Filled Too Soon
Providers are reminded that Drug Utilization Review (DUR) reject
message MW (DUPLICATE DRUG) will appear when the client has received
the same drug (same chemical entity) and has used less than two-thirds
of the medication based on the number of days supply provided in
the previously submitted claim. If a provider uses an intervention
code to override the DUR reject message, the prescription or client
profile at the pharmacy must contain specific documentation citing
the reason why the prescription was refilled early. The documentation
must be present at the time the drug is dispensed and the reason
for a "Fill Too Soon" refill cannot contravene any other
program guidelines. The absence of documentation will result in
a reclaim during the audit process.
The same documentation is required if a provider refills a prescription
too early but does not receive a DUR message due to an error in
recording the number of days supply on the previous claim. Once
again, the absence of documentation will result in a reclaim during
the audit process.
For further information, please refer to Section 5 of the NIHB
Pharmacy/MS&E Provider Information Kit (PPIK), which explains
the billing and payment information.
Original Prescription for Refills
Providers must retain a copy of the original prescription with
refills in accordance with their provincial or territorial requirements.
Audits are always based on a review of the original prescription
and the current refill hard copy, and payment will be reclaimed
if the original prescription is not available for review.
Special Submission Requirements - Infant Claims
First claims for infants under one year of age, who do not have
their own client identification number, must be submitted manually
with supporting parent identification using the NIHB Pharmacy Claim
Form.
The following information on the infant must be provided in the
top section of the NIHB Pharmacy Claim Form:
- Surname
- Given names
- Date of birth in the DD/MM/CCYY format
The following information on the parent must be provided in the
bottom section of the NIHB Pharmacy Claim Form:
- Surname
- Given names
- Date of birth in the DD/MM/CCYY format
- Client identification number or band and family number
For further information, please refer to Section 5.2 of the NIHB
Pharmacy/MS&E Provider Information Kit (PPIK), which explains
subsequent claim requirements.
Client Consent Warning Message W82
The following warning message has been reintroduced and will be
displayed on paid claims via POS as well as for each paid claim
line on your NIHB Pharmacy Claim Statement for clients who have
not provided consent:
W82 - Client has not provided consent
Note: W82 is transmitted as CPhA Code HH.
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 (ODB) Limited Use (LU) Drug Products (For Ontario Pharmacies Only)
For eligible NIHB clients over age 65 (or those eligible for other
reasons), Ontario pharmacists must coordinate drug benefits with
the Ontario Drug Benefit (ODB) program. Where drugs are listed
on the ODB Limited Use (LU) Drug Products list, Ontario pharmacists
must pursue approval through ODB. This may include contacting the
prescriber to have the prescription written on the ODB LU prescription
form. Results must be documented and kept on file in the NIHB client's
profile for review during on-site audit.
For further information, Ontario pharmacists are asked to refer
to Section 4 of the NIHB Pharmacy/MS&E Provider Information
Kit (PPIK), which explains the requirements for coordination of
benefits.
Yukon FNIHB Regional Office Change
The contact information for the Yukon FNIHB Regional Office has
changed. The changes are as follows:
FNIHB Yukon
First Nations and Inuit Health Branch
Health Canada
Elijah Smith Building
Suite 100 - 300 Main Street
Whitehorse, YT Y1A 2B5
1-867-667-3974
Fax: 1-867-667-3999
This update is reflected on prior approval confirmation letters
for MS&E items and the attached Directory for insertion into
the NIHB Pharmacy/MS&E Provider Information Kit (PPIK).
Attached is the updated Directory for your NIHB Pharmacy/MS&E
Provider Information Kit (PPIK). Please remove the existing Directory
and insert the revised one.
Published quarterly by First Canadian Health
Management Corporation Inc. at 3080 Yonge Street, Suite 3002, Toronto
ON M4N 3N1
|
