Non-Insured Health Benefits (NIHB) Newsletter for Medical Supplies
and Equipment Providers - Winter 2005-2006
News and Information for our NIHB Providers
NIHB Toll-free Inquiry Centre: 1-888-471-1111
For our Medical Supplies and Equipment Suppliers (MS&E) -
Winter 2005-2006
News and Views
Welcome to the Winter 2005-2006 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 1-888-471-1111, or send your
correspondence to:
FCH Provider Relations
3080 Yonge Street, Suite 3002
Toronto, ON M4N 3N1
Item Cost Field
The amount entered in the "Item Cost" field on the NIHB MS&E
Claim Form must be the total acquisition cost of all units of
the item dispensed for the claim. In other words, the amount in the "Item
Cost" field represents the quantity dispensed multiplied by the unit
cost of the item. Failure to enter the correct amount in this field
will result in claims being returned unprocessed to providers.
For additional information, please refer to Section 7.5 of the NIHB
Medical Supplies and Equipment (MS&E) Provider Information Kit.
Amount Claimed Field
The total amount entered in the "Amount Claimed" field on the NIHB
MS&E Claim Form must be the sum of the item cost, dispensing
fee and the mark-up for the item, less any third party share. Failure
to enter the correct amount will result in claims being returned unprocessed
to providers.
For additional information, please refer to Section 7.5 of the NIHB
MS&E Provider Information Kit.
Appeal Process
When a client is denied a benefit, there are three levels of appeal
available under the NIHB Program. Providers are reminded that appeals
can only be initiated by the client, or with written confirmation that
the client is aware that the appeal is being submitted on his/her behalf.
Appeals submitted by providers without client confirmation, will not
be subject to review.
NIHB MS&E Provider Audit Program
The Non-Insured Health Benefits (NIHB) Audit Program has recently conducted
on-site provider audits. The NIHB Audit Program has determined that the
most frequent reason for recovery is the prescription not being found
on site.
As per provincial regulations and NIHB Program requirements, providers
are expected to retain original or faxed prescriptions for review during
an on-site audit. Faxed prescription must include the mandatory transmission
information (which includes the date sent and the sender's information)
in order to be valid. The prescriptions therefore, should not be cut
to fit the Rx cases.
In conclusion, the absence of the original or faxed prescription in
the client's file during an on-site audit will result in the recovery
of claim(s) associated with the prescription.
The NIHB Program's billing requirements are detailed in the NIHB
MS&E Provider Information Kit , First Canadian Health/NIHB
Program Newsletters, and NIHB Program MS&E Bulletins. These documents
can be accessed at the following NIHB
website:
www.hc-sc.gc.ca/fnih-spni/nihb-ssna/benefit-prestation/medequip/index_e.html
Failure to comply with the requirements of the NIHB Program may result
in the recovery of affected paid claims. Providers are advised to review
the key documentation in order to be aware of NIHB Program requirements.
Published quarterly by First Canadian Health Management Corporation
Inc. at 3080 Yonge Street, Suite 3002, Toronto, ON M4N 3N1
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