Who may call the Provider Claims Processing Call Centre?
The Provider Claims Processing Call Centre is reserved for pharmacists, dentists, and Medical Supplies and Equipment providers.
How long do I have to submit my claims to Express Scripts Canada for payment?
Please submit the claims as soon as possible, as claims with a service date of over one year will not be honored.
Where do I send my manual (provider) claims?
Please send the claims by mail to the NIHB Claims Services Department, 3080 Yonge Street, Suite 3002, Toronto, Ontario, M4N 3N1. Providers should be encouraged to submit manual claims regularly.
Which date do I record for the service date?
a) The service date refers to the date on which the item is dispensed or the date on which the services were provided.
b) For those services rendered over several visits, where insertion of an appliance is required, the service date is the date on which the appliance was inserted.
c) For those services rendered over several visits, where insertion of an appliance is not required, the service date is the date on which the service was completed.
Does Express Scripts Canada accept computerized claim forms for NIHB claims?
a) Yes, computerized claim forms are acceptable, provided that all the required data elements are included.
b) For a list and description of required data elements, refer to the following: Pharmacy claims, NIHB Pharmacy Claims Submission Kit Attachments – Mandatory Information in Transmission and Submission Options; MS&E claims, NIHB MS&E Claims Submission Kit Attachments – Mandatory Information in Transmission and Submission Options, and for Dental claims, NIHB Dental Claims Submission Kit Attachments – Submission Options and Mandatory Data to be Submitted in Dental Claims.
I just received my Provider Identification Number. Can I submit claims now or is there a waiting period?
There is no waiting period for submitting claims. Include the Provider Identification Number on all claims, and any correspondence submitted to Express Scripts Canada.
Who do I notify for a change in address or contact information?
Providers should complete and send a Modification to Information Form to Express Scripts Canada Provider Relations by fax to 855-622-0669 (toll free) or by mail to c/o ESI Canada, Attention: Provider Relations Department, 5770 Hurontario Street, 10th Floor, Mississauga, Ontario, L5R 3G5.
How will I know if new documents are posted to the NIHB Claims Services Provider Website?
When new documents are posted on the NIHB Claims Services Provider Website, Express Scripts Canada creates an alert in the website’s notice area.
Are there written instructions that will help me to locate, download, and print documents from the NIHB Claims Services Provider Website?
Help documentation including instructions on how to navigate the NIHB Claims Services Provider Website is available on the website.
How will I be informed if there are HICPS system issues?
Providers will be informed via alerts on the home page of the NIHB Claims Services Provider Website.
How will I be advised of changes to HICPS?
Communication will be posted on the announcement section of the NIHB Claims Services Provider Website.
Click here to access the FAQs for the Independent Dental Hygienist Provider Program with the First Nations Health Authority (FNHA) Health Benefits Program.