Medical Supplies and Equipment Bulletin - Audiology Benefits - February 2001

Help on accessing alternative formats, such as PDF, MP3 and WAV files, can be obtained in the alternate format help section.

(67 KB)

The Non-Insured Health Benefits (NIHB) Program provides supplementary
health benefits, including Medical Supplies and Equipment, to
eligible First Nations and Inuit throughout Canada.

This NIHB Medical Supplies and Equipment Bulletin - Audiology Benefits provides information about the audiology benefits available under the NIHB Program. It includes an overview of NIHB policy, the prior approval process, repairs, replacement and warranty guidelines. Providers can find more detailed information in the NIHB MS&E Provider Information Kit.
Information is also available on the NIHB web site at http://www.hc-sc.gc.ca/fnihb/nihb/mse/provider_kit.pdf

In January 1999, a review of the MS&E benefits was undertaken as part of a larger effort to improve the management of the NIHB Program and to ensure that the benefits reflect client needs, current clinical practices, changes in health care delivery and NIHB policy. The changes resulting from the review will be implemented on April 1, 2001. Please note that the range of benefits provided remains the same although additional benefit codes have been added to the Audiology Benefit List to clearly identify eligible benefits and to enable the NIHB Program to perform comprehensive benefit utilization analysis and audit activities.

The following will be implemented on April 1, 2001:

• all audiology benefits (except batteries and hearing aid repairs) continue to require a prescription from a medical practitioner or specialist in the field of audiology;
• audiology benefits must be provided by an audiologist or hearing aid dispenser;
• audiometric tests and a description of the currently used hearing aid are required for all new or replacement hearing aid requests;
• there is no longer a code for binaural hearing aids, providers must identify left and right ear hearing aids separately using the new codes;
• dispensing or fitting fees are to be split equally between left and right hearing aids, when both are provided.

Prior Approval Process

The NIHB Hearing Aid and Hearing Aid Repair Prior Approval Request Form is required for all benefits, except batteries. In the case of a new or a replacement hearing aid a copy of the most recent audiometric test and, if applicable, current hearing aid information (manufacturer name, model number or name, date of fitting, serial number), must be included in section 3 of the Form. The Form, the prescription and the audiometric test must be returned to the First Nations and Inuit Health Branch (FNIHB) Regional Office for review. If a prior approval is granted, a PA number will be provided for billing purposes. If a prior approval is not granted, the provider will be advised of the reason and will be asked to inform the client of his or her right of appeal.

In the case of a repair, either in-office or out-of-office, the NIHB Hearing Aid and Hearing Aid Repair Prior Approval Request Form must also be completed and must include the reason for the request.

Once a hearing aid has been dispensed or repaired, the provider must complete the NIHB Hearing Aid and Hearing Aid Repair Confirmation Form. The provider's signature is required on the Form to confirm that the client has received and is satisfied with the equipment or repair and the instructions provided. The Form must then be returned to the FNIHB Regional Office, and a copy maintained by the provider for audit purposes.

For British Columbia - providers are to continue to follow the procedures outlined in the Hearing Aid Program, Policies, Procedures and Standards recently put in place by the Pacific Regional Office of the First Nations and Inuit Health Branch.

Recommended Replacement and Warranty Guidelines

Guidelines outlining recommended quantities or replacements are based on the average needs of clients. Requests exceeding these guidelines may be considered on a case by case basis if medical need is demonstrated. All warranty coverage must be exhausted before repairs or replacements can be considered.

NIHB MS&E Claim Form

The client address section of the NIHB MS&E Claim Form must be completed prior to sending to First Canadian Health for payment. If the address field is not completed, the Form will be returned to the provider for completion.

Please note that claims dated over one year from the date of service will not be considered for payment.