All notifications as NIHB providers are subject to verification by the program. NIHB supplier numbers are processed according to the administrative requirements of the NIHB program. When making claims, suppliers are required to pass on the usual and customary rebate costs to the NIHB program in accordance with their agreement to supply supplies and equipment to pharmacies or medicine. In addition, suppliers are required to update the usual and customary fees in their system on the basis of agreed taxes. This section outlines policies and procedures for health care providers that cover uninsured health care. It contains information on nihb (non-Insured Health Benefits) policies and lists and refers to claims processing procedures available on Express Scripts Canada`s NiHB Claims Provider website. As a supplier, it is important that you read and understand the terms and conditions of the program described in the Claims Submission Kits (www.provider.esicanada.ca). Filing a claim by you shows your understanding and acceptance of the terms and conditions of the NIHB program. Failure by the Supplier to comply with these terms and conditions may result in the suspension or removal of your billing privileges under the NIHB program, as well as all necessary restoration mechanisms. Program guidelines and information on the transmission of claims/payment are made available to suppliers with respect to the following information: persons eligible for the DE NIHB programme have the right to appeal the refusal of a benefit, with the exception of items identified as exclusions or insured benefits.
When a customer requests information about the claim process, pharmacy providers can forward it to online claims procedures or to the appropriate Regional First Nations and Inuit Health Branch office. Suppliers wishing to provide services to NIHB customers must register/register with Express Scripts Canada. For more information, please visit the Express Scripts Canada Non-Insured Health Benefits Provider (www.provider.esicanada.ca) or call the Express Scripts Canada Provider Claims Processing Call Centre at 1-888-511-4666. For claims that are completed on the same day, the electronic claims assessment system allows a single transaction up to a maximum delivery of 7 days or more of a transaction for a combination of up to 7 days coverage. Pharmacy providers should be aware that NIHB only pays one supplier`s fees per day and only if the entire « daily supply » has passed from an earlier service date. Applications must be submitted based on the date of the service provided. When pharmacy providers decide to crush a rejection message with an intervention code, they must complete and keep the corresponding documents on the type of intervention directly on the recipe or on a hard or electronic version of the customer file. In order to avoid debt recovery during the claims review and review process, appropriate documentation of an intervention is required. It should apply: the NIHB programme reimburses suppliers for their usual and customary collection fees by taking oral buprenorphine/naloxone (Suboxone® and generics) up to the regional limit of the programme.
If the treatment of the drug is an eligible combination and it is not possible to reintegrate it into the pharmacy inventory, Express Scripts Canada pays the supplier for both the drug and the sale costs. There is therefore no need to turn back.