Non-Insured Health Benefits (NIHB) Newsletter
First Canadian Health
News and Information for our NIHB Providers
NIHB Toll-free Inquiry Centre: 1-888-471-1111
For our Medical Supplies and Equipment Suppliers - Spring 2004
News and Views
Welcome to the spring 2004 edition of the Non-Insured Health Benefits
(NIHB) quarterly newsletter. First Canadian Health (FCH) is now
in its sixth 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 1-888-471-1111, or send
your correspondence to:
FCH Provider Relations
3080 Yonge Street, Suite 3002
Toronto, ON M4N 3N1
New Approach to the NIHB Program's Consent Initiative
On February 4, 2004, Health Canada announced a new approach to
the NIHB Program's Consent Initiative. The new approach means that
the March 1, 2004, deadline for the submission of consent forms
by NIHB First Nations and Inuit clients no longer applies. Under
this new approach, the NIHB Program will not require a signed consent
form for day-to-day processing activities and program administration.
NIHB clients will therefore continue to receive benefits for which
they are eligible even if they have not signed a consent form.
Health Canada would like to express its appreciation to those
providers who assisted in, and supported, the NIHB Program's Consent
Initiative.
For more details on the new approach to the initiative, please
visit Health Canada's website at the URL address:
www.hc-sc.gc.ca/fnihb/nihb/consent/urgent_noticefeb.htm
Providers may also contact the NIHB Consent Information Centre
at 1-888-751-5011.
Consent Warning Message: W82
Providers will continue to receive the warning message W82
(Client has not provided consent) on paid claims for
clients who have not provided consent.
Providers are asked to disregard this warning message
as the March 1, 2004 deadline no longer applies.
Questions regarding the W82 warning message can be directed to
the FCH NIHB Toll-Free Inquiry Centre at 1-888-471-1111.
Reminder -- MS&E Prior Approvals
Medical supply and equipment (MS&E) benefits requiring a prior
approval must be authorized BEFORE the benefit is provided to the
client. The NIHB program will not authorize or backdate an MS&E
benefit simply because the provider has already dispensed the item.
Providers who choose to dispense the item before obtaining funding
approval from the NIHB program do so at their own risk.
Providers may dispense oxygen on an emergency basis when the FNIHB
Regional Office is closed, providing they know the client is eligible
and meets the medical criteria for oxygen. The approval can be
obtained once the FNIHB Regional Office re-opens. Please refer
to Section 4.4 of the NIHB MS&E Provider Information Kit for
further information regarding oxygen therapy.
Band #458 -- Bigstone Cree Nation
The Bigstone Health Commission assumed complete management of
MS&E benefits on behalf of the members of Bigstone Cree Nation
(Band #458) on February 1, 2004. This means that claims and prior
approvals with a date of service (DOS) on or after April 1, 2003
should be submitted to Bigstone Health Commission. Claims submitted
to FCH with a DOS on or after April 1, 2003, will be rejected with
the message R30 (Client has alternative coverage. Contact
FNIHB). Claims with a DOS prior to April 1, 2003 must
be submitted to FCH and will be processed as usual. Predeterminations
with a DOS prior to April 1, 2003 must be sent to FNIHB.
Bigstone Health Commission's contact information is:
Attn: Mabel Gladue
Bigstone Health Commission
P.O. Box 1590
Wabasca, AB T0G 2K0
Phone: (780) 891-4161
Toll Free: 1-866-891-9719
Fax: (780) 891-3222
Delivery Codes
Prior to November 2003, delivery charges for remote and isolated
areas had to be included in the cost of the items, or billed using
the code for miscellaneous items. To improve the management of
the program, NIHB created delivery codes to track those expenditures
effective November 1, 2003. NIHB guidelines on delivery
charges have not changed, only the tracking of these
charges has been modified. The use of delivery codes requires a
prior approval by the FNIHB Regional Office.
Supporting Documentation
Providers are reminded to keep appropriate documentation in support
of each claim for two years from the date a prescription is dispensed.
For refills, the original prescription must be kept on file for
two years after the most recent dispense date. Claims without supporting
documentation may be recovered through the audit program. This
applies to all paid claims, including those with prior approvals.
For further information on the MS&E Audit Program, please
refer to Section 3 of the NIHB MS&E Provider Information
Kit.
Change of Ownership
When an MS&E supplier changes ownership, the provider number
under which the business is registered cannot be used by the new
owner(s) to submit claims. This applies even if the name of the
supplier remains the same. Instead, the provider number must be
end dated and the new owner(s) must complete their own Pharmacy/MS&E
Provider Agreement. Once the Agreement has been approved,
the MS&E supplier will be assigned a new provider number to
be used for billing.
To obtain a copy of a Pharmacy/MS&E Provider Agreement,
please contact the FCH NIHB Toll-Free Inquiry Centre at 1-888-471-1111.
Published quarterly by First Canadian Health Management Corporation
Inc. at 3080 Yonge Street, Suite 3002, Toronto ON M4N 3N1
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