Non-Insured Health Benefits (NIHB) Newsletter
News and Information for our NIHB Providers
For our Pharmacy Providers in Saskatchewan
Spring 2005
News and Views
Welcome to the spring 2005 edition of the Non-Insured Health Benefits
(NIHB) quarterly newsletter. First Canadian Health (FCH) is now
in its seventh 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 1-888-511-4666,
or send your correspondence to:
FCH Provider Relations
3080 Yonge Street, Suite 3002
Toronto, ON M4N 3N1
Spring 2005 NIHB Drug Benefit List Update
Please find attached the Spring 2005 updates, which list all changes
made to the NIHB Drug Benefit List (DBL) since the last update
for Winter 2004-2005. These updates include the addition and replacement
of Drug Identification Numbers (DIN), limited use benefits, drugs
removed from the Canadian market and drugs discontinued by the
manufacturer effective April 1, 2005.
These updates are reflected in the most recent electronic version
of the NIHB DBL.
To be added to the distribution list for a hard copy of the April
1, 2005 reprint of the full NIHB DBL, submit a request using the
form below. Please fax this page to (613) 941-6249 no
later than June 1, 2005. After that time, hard copies of the April
1, 2005 reprint of the NIHB DBL will not be provided.
Name:
Provider Number:
Street Address:
City:
Province.
Postal Code:
Email:
Should you have any questions, please contact the FCH NIHB Toll-Free
Inquiry Centre at 1-888-511-4666.
Frequency Limit for Disposable Diapers and Briefs
As of January 1, 2005, the frequency limit for disposable diapers
and briefs is a maximum of 450 diapers/briefs per three-month period.
This frequency limit applies to the following item codes:
- 99400436 - Pant, briefs, disposable
- 99400440 - Diaper disposable, medium, adult
- 99400750 - Diaper disposable, small, youth, adult
- 99400751- Diaper disposable, large adult
- 99400752 - Diaper disposable, child over 2 years of age
- 99400753 - Diaper disposable, large/extra large, child over
2 years of age
For a list of the disposable diapers and briefs covered by the
NIHB Program, please refer to Sections 10B.2.5 and 10B.8 of the NIHB
Pharmacy/Medical Supplies and Equipment (MS&E) Provider Information
Kit.
Quantity Limitations for MS&E Items
MS&E items that have an annual quantity limitation must be
provided and claimed for no more than a three-month period at a
time. This applies to items with or without a prior approval number.
Items must be claimed in individual units, not packages or boxes,
unless otherwise indicated (e.g. gloves) in the recommended replacement
guidelines column of the MS&E benefit lists in the NIHB
Pharmacy/MS&E Provider Information Kit. For example:
- Irrigation Syringes (item code 99400320): The quantity limitation
is 24 syringes per year, therefore a maximum of 6 syringes can
be provided and claimed per three-month period.
- Batteries for left hearing aids (item code 99400259): A maximum
of 12 individual batteries can be claimed every 3 months.
Claims for MS&E items that are submitted with quantities in
excess of the amount allowed during the three-month period are
subject to reversal or recovery through the audit program.
"Refusal to Fill" Claims
Saskatchewan providers are reminded that a "Refusal to Fill" claim
must not be submitted for a prescription that is placed on hold
while consulting with the prescriber. The "Refusal to Fill" claim
must only be submitted once the pharmacist determines to not fill
the prescription.
Providers can download a current version of the NIHB Pharmacy/Medical
Supplies and Equipment Provider Information Kit from the
NIHB website.
Providers without internet access can contact the FCH NIHB Toll-Free
Inquiry Centre at 1-888-511-4666 .
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