Dental Bulletin - October
2005
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Announcement of Changes to Dental Benefits
The Non-Insured Health Benefits (NIHB) Program
provides supplementary health benefits, including dental treatment,
for registered First Nations and recognized Inuit throughout Canada.
Visit our Website at: www.healthcanada.gc.ca/nihb
The June 2005 Program changes, the Revised NIHB Regional Dental
Benefit Grid and NIHB Dental Policy Framework have been implemented
to make the benefits of the NIHB Program more understandable to
providers, to provide consistency in the application of benefits,
to streamline administration, and to facilitate use of the EDI
claims submission process. These changes are a result of the recommendations
from the January 2005 Federal Dental Care Advisory Committee (FDCAC)
meeting, involving the Assembly of First Nations (AFN), the Inuit
Tapiriit Kanatami (ITK) and the Canadian Dental Association (CDA).
This process complemented the ongoing work of the NIHB Dental Program
staff to improve access to care for First Nations and Inuit clients.
Effective June 1, 2005, the following changes have occurred
to the NIHB Dental Program:
- To facilitate claims submissions, the annual $800.00 threshold
has been removed. Previously, any procedures, including basic
services above this amount, required predetermination;
- The predetermination requirement for endodontic therapy on
anterior teeth (13-23 and 33-43 inclusive) has been removed;
and
- Providers can now add the necessary NIHB data elements to
the following accepted forms: The Standard Dental Claim Form,
ACDQ Dental Claim and Treatment Form, and computer generated
forms.
NIHB Regional Dental Benefit Grid
Effective October 1, 2005, the revised NIHB Regional Dental Benefit
Grid will be implemented and will replace the previous version.
The NIHB Regional Dental Benefit Grid identifies what services
require predetermination by placing benefits into one of the following
two schedules:
- Schedule A: outlines services that may be
provided and billed directly to First Canadian Health (FCH) for
payment, without predetermination, while taking into account
identified Program limits.
- Schedule B: outlines services that require
predetermination. The predetermination process remains unchanged
and is administered through the NIHB Regional Offices.
In addition, the revised grid includes:
- Implementation of the Crown, Periodontic and Revised Endodontic
Policy; and
- Removal of program limits on selected services (for example:
retentive pins).
Please refer to Schedule A and B of the NIHB Regional Dental Benefit
Grid and NIHB Dental Policy Framework for details of changes now
incorporated in the NIHB Dental Program.
Note: Denturist grids will not be split into A and B Schedules.
NIHB Dental Policy Framework
The NIHB Dental Policy Framework defines the policies of the Program,
the eligibility requirement for clients, the types of benefits
to be provided and criteria under which they will be funded. Policies
in this framework include the following:
- Revised Endodontic Policy
- Crown Policy
- Periodontic Policy
- Orthodontic Policy
For more information on the Framework and other NIHB documents,
please refer to the Health Canada Website at: www.healthcanada.gc.ca/nihb,
or contact your FNIHB Regional Office.
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