Dental Bulletin - June 2005

Dental Bulletin
Non-Insured Health Benefits Program

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The Non-Insured Health Benefits (NIHB) Program provides supplementary health benefits, including dental treatment, for registered First Nations
and recognized Inuit throughout Canada.

Important Changes to the NIHB Dental Program -
Effective July 1, 2005

• Removal of the $800 threshold;
• Endodontic policy change for anterior teeth (13-23, 33-43 inclusive);
• Acceptance of the Standard Dental Claim Form, ACDQ Dental Claim and Treatment Form, computer generated form;
• NIHB Dent-29 Form is only required for pay client, client reimbursement submissions, and claims payable to third party;
• Streamlining of amendment request practices;
• Postal code correction for the Orthodontic Review Centre; and
• Maximum funding for anterior restorations.

Removal of Threshold

Effective July 1, 2005, the $800 threshold will be removed. Please note only procedures with a "P" and procedures that are exceptions to the Program continue to require predetermination (PD) prior to commencing treatment.

Endodontic Policy Change

Effective July 1, 2005, endodontic therapy on anterior teeth (13-23, 33-43 inclusive) (procedure codes 33111 and 33100) may be completed without predetermination. Predetermination for bicuspid and molar teeth remains mandatory.

Attention:

In order to ensure payment without rejection (error code R50 frequency of the claim exceeds the maximum allowable), and until system changes can be made, it is recommended that providers contact their FNIHB Regional Office to obtain a predetermination number that must be provided on the claim submission.

Standard Dental Claim Form, ACDQ Dental Claim and Treatment Form, Computer Generated Form

Effective July 1, 2005, the Standard Dental Claim Form, ACDQ Dental Claim and Treatment Form, or a computer generated form will be accepted for PD and claim submissions.

PD submissions must include the following information:

• client identification number or band and family numbers (band and family numbers do not apply for Inuit clients), date of birth (DOB);
• tooth charting; and
• supporting documentation (e.g., radiographs) and all data elements as outlined in the NIHB Dental Practitioner Information Kit (DPIK).

Claim submissions must include the following information:

• client identification number or band and family numbers (band and family numbers do not apply for Inuit clients), date of birth (DOB);
• Predetermination (PD)/Preverification (PV) number(s) must be provided and must be relevant to the claim line being submitted; and
• all data elements, excluding client signature.

Attention:

The NIHB Dent-29 Form must still be used for:

• pay client and client reimbursement; and
• claims payable to a third party.
• Original and fax copies of the NIHB Dent-29 Form are available by contacting the FCH NIHB Toll-Free Inquiry Centre at: 1-888-471-1111.

Streamlining of Amendments

Minor amendments to PD (e.g., procedure code or tooth number changes) may be made by phone, fax, or by submitting a Standard Dental Claim Form, ACDQ Dental Claim and Treatment Form, computer generated form, or a NIHB Dent-29 Form to your FNIHB Regional Office.

Maximum Funding of Permanent Anterior Restorations

Since April 22, 2005, the professional fee for permanent anterior teeth is limited if more than five restorative surfaces are claimed for the same tooth, with the same date of service. The professional fee is limited to the amount allowed for five surfaces. The warning message W31 (Reduced to maximum surfaces allowed per tooth including previous claim) appears on the NIHB Dental Claim Statement.

Orthodontic Review Centre (ORC) Postal Code Correction

Please note the correct postal code for the ORC:
Orthodontic Review Centre
Non-Insured Health Benefits Program
First Nations and Inuit Health Branch
Health Canada
Graham Spry Building
250 Lanark Avenue, 6th Floor
Postal Locator 2006C
Ottawa, ON K1A 0K9

Toll-free phone: 1-866-227-0943
Toll-free fax: 1-866-227-0957

NIHB Dental Program

For more information on policies and benefits of the Program, please refer to the Dental Practitioner Information Kit.