Non-Insured Health Benefits (NIHB) Newsletter
For our Pharmacy Providers - Spring 2006

Prepared by First Canadian Health
News and Information for Our NIHB Providers
NIHB Toll-Free Inquiry Centre: 1-888-511-4666

News and Views

Welcome to the spring 2006 edition of the Non-Insured Health Benefits (NIHB) quarterly newsletter. First Canadian Health (FCH) is now in its eighth 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

Up and Coming on the Web

New and easy access to NIHB Provider Information Kits is coming soon! Starting in the spring of 2006, accessing provider information on Health Canada's website will be quicker and easier. We are currently combining the Provider Information Kits and the NIHB Drug Benefit List (DBL) into one central site that will allow you to view and print the material in a few simple steps. Visit the new site at http://www.healthcanada.gc.ca/nihb under 'Health Provider Information' to find the new kits.

Publishing of the NIHB DBL will continue to occur once a year and its updating will continue on a quarterly basis. You can access the most recent electronic version anytime online at http://www.healthcanada.gc.ca/dbl.

NIHB Drug Benefit List (DBL) Update

The spring 2006 DBL updates, which list all changes made to the NIHB DBL since the last update for winter 2005-2006, will be available on the NIHB website from April 1, 2006. 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, 2006. The most recent electronic version of the NIHB DBL reflects these updates. Please refer to the website at the following URL address: www.hc-sc.gc.ca/fnih-spni/pubs/nihb-ssna_e.html

Add your pharmacy to the distribution list for a hardcopy of the April 1, 2006 reprint of the NIHB DBL by submitting a request using the following form:

Please complete the fields in the shaded box below, and fax this page to (613)-941-6249 no later than June 1, 2006. FNIHB will not provide hardcopies of the April 2006 DBL reprint after June 1, 2006.

Yes! Please send a hardcopy of the April 1, 2006 DBL update to our office....

Name:
Provider Number:
Address:
City:
Province:
Postal Code:
Telephone:
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Should you have any questions, please contact the FCH NIHB Toll-Free Inquiry Centre at 1-888-511-4666.

Changes to the Electronic Claims Submission Network

Emergis Inc. completed an upgrade of its electronic claims submission network in February 2006. As a result, it is necessary that all Canadian claims processing software be reconfigured in order to permit claims submission to insurers, third party payers, and claim adjudicators via the improved network.

If your office has received a "Host Unavailable" or "Host Time Out" message while attempting to submit claims electronically, FCH recommends that you contact your software vendor for assistance in completing the necessary upgrades. If you require further information, please contact the FCH NIHB Toll Free Inquiry Centre at 1-888-511-4666.

Billing of Extemporaneous Mixtures

Findings by NIHB's Provider Audit indicate that claims submitted under the pseudo-DIN for extemporaneous mixtures are often inappropriate. Please note that the NIHB program defines extemporaneous mixtures as:

".products that require compounding in a pharmacy in accordance with the orders of a prescriber and which must not duplicate the formulation of commercially manufactured drug products."

An example of inappropriate billing of extemporaneous mixtures is as follows; A prescription indicates "25mg of Hydrochlorothiazide (HCTZ) - take ½ tablet daily,"the pharmacy splits the pills in half and submits the claim as an extemporaneous mixture.

If the pharmacy splits the pills on behalf of the client, this claim must be submitted using the HCTZ 25mg DIN and not as an extemporaneous mixture. According to the aforementioned definition of extemporaneous mixtures, the claimed item duplicates the formulation of a commercially manufactured drug product and would be recovered in the audit process were it submitted under the pseudo-DIN for extemporaneous mixtures.

As a reminder, claims submitted for extemporaneous mixtures containing exceptions, limited use benefits, or for commercially manufactured drugs without a prior approval number, will be subject to reversal.

The NIHB Pharmacy/Medical Supplies and Equipment Provider Information Kit, First Canadian Health/NIHB Program Newsletters, and NIHB Program Drug Bulletins all detail the NIHB Program's billing requirements. These documents are available on the NIHB Web site at: www.hc-sc.gc.ca/fnih-spni/pubs/nihb-ssna_e.html.

Prior Approval for Diclofenac

The NIHB program reviewed a submission request for diclofenac topical preparation and concluded that the evidence base for the utilization of diclofenac in a topical form was not sufficient to recommend the addition of this product to the NIHB Drug Benefit List. Therefore, a pharmacist receiving a prescription to dispense a topical preparation containing diclofenac must obtain prior approval from the National Drug Exception Centre before dispensing the preparation. This applies even when diclofenac oral tablets are the primary ingredient in the compound.

It is important to remember that a pharmacist will not receive payment for any compounds that replicate a drug product already available on the market. Please note that all claims submitted to the NIHB program are subject to audit.

Discrepancies in quantity and Days Supply (Seven-Day Blister Packs)

Audit findings have identified situations where the quantity/days supply recorded on claims for Seven-Day Blister Packs is contradictory to the quantity indicated on the package. The days supply for a Seven-Day Blister Pack must always be seven with any applicable refill billing processed only after two-thirds (2/3) of the previous fill.

Accurate reporting of the days supply is essential for the adjudication and verification of claims. Providers must indicate the number of days treatment contained in the prescription.

Submitting Claims for AeroChamber ® Valved Holding Chambers (VHCs)

Please submit the correct item code or pseudo-DIN when submitting claims for AeroChamber ® VHCs. For example, when dispensing an adult-size AeroChamber ® to an adult, the item code or pseudo DIN submitted for payment must be for an adult-size AeroChamber ®.

Recent audits have uncovered numerous instances where payment was claimed using the incorrect pseudo-DIN. Please ensure that all claims submitted for spacer devices use the correct pseudo-DIN.

The current version of the NIHB Pharmacy/Medical Supplies and Equipment Provider Information Kit is always available on the NIHB website at:

www.hc-sc.gc.ca/fnih-spni/pubs/index_e.html

Providers without internet access can contact the FCH NIHB Toll-Free Inquiry Centre at 1-888-511-4666.