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Provider News

Organizational Announcement

Tuesday, May 24, 2022

I am writing to share with you the news of my plans for retirement at the end of this year. This transition comes with mixed emotions as I reflect on all that we have achieved together at Pacific Blue Cross.

Pharmacy | FNHA Harm Reduction Hub

Monday, Nov 29, 2021

The First Nations Health Authority is providing naloxone nasal spray kits to First Nations community partners through the Harm Reduction Hub.

Supporting members affected by floods

Thursday, Nov 18, 2021

Pacific Blue Cross stands with the people across the province affected by the devastating floods and damage to BC’s transportation infrastructure

More Articles

Pharmacy Providers

Changes to dispensing fee limits for Municipal Pension Plan effective January 1, 2021

The Municipal Pension Plan will be introducing new dispensing fee limits effective January 1, 2021. These limits will be applied to defined sets of drugs used to manage chronic conditions (the Maintenance Drugs list).

Dispensing fees for solid-oral drugs (tablets and capsules) included on the Maintenance Drugs list will be limited to five per year. All other solid-oral drugs used to treat chronic conditions will be limited to 13 dispensing fees per calendar year. No other Pacific Blue Cross policy numbers are affected at this time.

When a claim is submitted in excess of these limits, PBC will return the CPhA response code 87 “exceeds max # of prof. fees for this drug”. The cost of the medication will still be reimbursed according to the terms and conditions of the plan. However, the dispensing fee portion of the claim will not be eligible under the plan.

Approximately 6,155 current plan members will be impacted by these new limits, and we will be notifying them by mail in November. We are encouraging members to discuss this change with their pharmacist to ensure the smoothest possible transition on January 1, 2021.

 

Healthcare Providers

COVID-19 (coronavirus) update for Healthcare Providers

As BC's health benefits society, we want to ensure our members and providers have the tools they need to navigate the most recent developments related to COVID-19 (coronavirus). To stay up to date on the latest information, we recommend that all health providers in British Columbia continue to follow advice from the BC Centre for Disease Control, their Professional College, as well as the government of BC. 

Recent updates for Healthcare Providers in BC:

 

Chiropractors

Pacific Blue Cross has been working hard to enable to policies and practices to enable Tele-Health Services for Chiropractors.  As of March 24th, 2020 Chiropractors can now bill Tele-Health Services to Pacific Blue Cross for those plans with Chiropractic Services as an eligible benefits.  Benefits vary from plan to plan.

Please note the following requirements:

  • As of March 24, Chiropractic Tele-Health services can be billed for subsequent visits. 
  • As of April 27, Chiropractic Tele-Health services can be billed for initial visits.
  • Chiropractic Tele-Health services must all meet all regulations as outlined by the College of Chiropractors of British Columbia, specifically amendments to the Professional Conduct Handbook (PCH) Part 3 Provision of Care and Privacy and the addition of Appendix “P” Telehealth.
  • All receipts issued must include “Tele-health” for these services.
  • NOTE:  Benefits vary from plan to plan. Members should verify benefits coverage for telehealth services prior to appointment.

Claims processing and payment processing: Go digital

A situation like COVID-19 highlights the many advantages there are for you, our members, and Pacific Blue Cross by capitalizing on the digital capabilities we offer. For the fastest claim turnaround, payment through direct deposit, and to minimize paper and physical mail processing, we encourage you to enable our digital options if you have not yet done so. 

Register for PROVIDERnet to get convenient online access to:

  • check patients’ claim eligibility
  • submit claims
  • view fee schedules, predeterminations, and statements

 

Massage Therapy

Please visit the CMTBC website for important information and guidance. 

Claims processing and payment processing: Go digital

A situation like COVID-19 highlights the many advantages there are for you, our members, and Pacific Blue Cross by capitalizing on the digital capabilities we offer. For the fastest claim turnaround, payment through direct deposit, and to minimize paper and physical mail processing, we encourage you to enable our digital options if you have not yet done so. 

Register for PROVIDERnet to get convenient online access to:

  • check patients’ claim eligibility
  • view fee schedules, predeterminations, and statements
  • submit claims

 

Naturopathy

Pacific Blue Cross would like to remind Naturopaths that Tele-Health Services are available for members who have plans with Naturopathy benefits.

Please note the following requirements:

  • Tele-Medicine must meet all the regulations as outlined by the College of Naturopaths of British Columbia, specifically the Standards of Practice: Tele-Medicine
  • The Naturopath providing Tele-Medicine services must be licensed to practice in the jurisdiction of member residence.
  • All receipts issued must include “Tele-medicine” for these services.
  • Insta-Claim submissions must indicate “Tele-medicine” in the nature of illness/injury field for reporting purposes.

All receipts issued must include “Tele-medicine” for these services​

Please visit http://www.cnpbc.bc.ca/public-notice-novel-coronavirus-covid-19/ to stay up to date on the latest advice and information regarding COVID-19 (coronavirus) from the College of Naturopathic Physicians of British Columbia.

Claims processing and payment processing: Go digital

A situation like COVID-19 highlights the many advantages there are for you, our members, and Pacific Blue Cross by capitalizing on the digital capabilities we offer. For the fastest claim turnaround, payment through direct deposit, and to minimize paper and physical mail processing, we encourage you to enable our digital options if you have not yet done so. 

Register for PROVIDERnet to get convenient online access to:

  • check patients’ claim eligibility
  • view fee schedules, predeterminations, and statements
  • submit claims

 

Physiotherapy

Pacific Blue Cross has been working hard to enable to policies and practices to enable Tele-Health Services for Physiotherapists.  As of March 24th, 2020 Physiotherapists can now bill Tele-Rehabilitation Services to Pacific Blue Cross for those plans with Physiotherapy as an eligible benefit.  Benefits vary from plan to plan.

Please note the following requirements:

  • As of March 24, Physiotherapy Tele-Rehabilitation can be billed for subsequent visits
  • As of April 27, Physiotherapy Tele-Rehabilitation services can be billed for initial visits.
  • Physiotherapy services must all meet all regulations as outlined by the College of Physical Therapists of BC whether services are provided in-person or via tele-rehabilitation.  
  • All receipts issued must include “Tele-rehabilitation” for these services.
  • NOTE:  Benefits vary from plan to plan. Members should verify benefits coverage for telehealth services prior to appointment.

Please visit https://cptbc.org/covid19/ to review the most current guidelines, information, and advice regarding COVID-19 (coronavirus) from the College of Physical Therapists of British Columbia.

Claims processing and payment processing: Go digital

A situation like COVID-19 highlights the many advantages there are for you, our members, and Pacific Blue Cross by capitalizing on the digital capabilities we offer. For the fastest claim turnaround, payment through direct deposit, and to minimize paper and physical mail processing, we encourage you to enable our digital options if you have not yet done so. 

Register for PROVIDERnet to get convenient online access to:

  • check patients’ claim eligibility
  • view fee schedules, predeterminations, and statements
  • submit claims

 

Psychology

Pacific Blue Cross would like to remind Psychologists that Tele-Health Services are available for members who have plans with Psychology benefits.

Please note the following requirements:

  • Tele-psychology services must meet all the regulations as outlined by the College of Psychologists of British Columbia, specifically The Code of Conduct.
  • The Psychologist providing tele-psychology services must be licensed to practice in the jurisdiction of member residence.
  • All receipts issued must include “Tele-psychology” for these services.
  • Insta-Claim submissions must indicate “Tele-psychology”  in the nature of illness/injury field for reporting purposes.
  • Insta-Claim submissions must indicate “Tele-psychology” in the nature of illness/injury field for reporting purposes.

 

Vision Providers

COVID-19 (coronavirus) update for Vision Providers 

As BC's health benefits society, we want to ensure our members and providers have the tools they need to navigate the most recent developments related to COVID-19 (coronavirus). To stay up to date on the latest information, we recommend that all health providers in British Columbia continue to follow advice from the BC Centre for Disease Control, their Professional College, as well as the government of BC. 

Recent updates for Opticians in BC:

  • Please refer to the latest update from the College of Opticians of British Columbia for important information regarding COVID-19 (coronavirus).
  • Opticians are advised to follow the usual advice for preventing the spread of infection and viruses including the Clinical Requirements as set out in the COBC Standards of Practice & Guidelines, section 3.3. You can also refer to the NACOR Bridging Course for Infection Control, including the corresponding learning resources.  

Claims processing and payment processing: Go digital

A situation like COVID-19 highlights the many advantages there are for you, our members, and Pacific Blue Cross by capitalizing on the digital capabilities we offer. For the fastest claim turnaround, payment through direct deposit, and to minimize paper and physical mail processing, we encourage you to enable our digital options if you have not yet done so. 

Register for PROVIDERnet to get convenient online access to:

  • check patients’ claim eligibility
  • view fee schedules, predeterminations, and statements

First Nations Health Authority: We’d like to remind you that vision claims made on behalf of First Nations Health Authority clients can now be processed online through PROVIDERnet for more efficient reimbursements. 

Recent updates for Optometrists in BC 

Claims processing and payment processing: Go digital

A situation like COVID-19 highlights the many advantages there are for you, our members, and Pacific Blue Cross by capitalizing on the digital capabilities we offer. For the fastest claim turnaround, payment through direct deposit, and to minimize paper and physical mail processing, we encourage you to enable our digital options if you have not yet done so. 

Register for PROVIDERnet to get convenient online access to:

  • check patients’ claim eligibility
  • view fee schedules, pre-determinations, and statements

First Nations Health Authority: We’d like to remind you that vision claims made on behalf of First Nations Health Authority clients can now be processed online through PROVIDERnet for more efficient reimbursements. 

Recent updates for Opthamologists in BC: 

Register for PROVIDERnet to get convenient online access to:

  • check patients’ claim eligibility
  • view fee schedules, pre-determinations, and statements

First Nations Health Authority: We’d like to remind you that vision claims made on behalf of First Nations Health Authority clients can now be processed online through PROVIDERnet for more efficient reimbursements.

First Nations Health Benefits is resuming normal service as a part of BC’s Restart Plan.  Each First Nations community is taking a different approach to COVID-19 depending on their circumstances. Providers who wish to travel into a community to deliver services should work closely with the leaders of that community to protect the health and safety of its residents.

Providers are advised to consult their association or college, as well as WorkSafeBC, for information on the health and safety protocols needed to protect providers and patients.

Hearing Service Providers

 
COVID-19 (coronavirus) update for Hearing Providers 

As BC's health benefits society, we want to ensure our members and providers have the tools they need to navigate the most recent developments related to COVID-19 (coronavirus). To stay up to date on the latest information, we recommend that all health providers in British Columbia continue to follow advice from the BC Centre for Disease Control, their Professional College, as well as the government of BC. 

Claims processing and payment processing for First Nations Health Authority: Go digital

A situation like COVID-19 highlights the many advantages there are for you, our members, and Pacific Blue Cross by capitalizing on the digital capabilities we offer. For the fastest claim turnaround, payment through direct deposit, and to minimize paper and physical mail processing, we encourage you to enable our digital options if you have not yet done so. 

We’d like to remind you that vision claims made on behalf of First Nations Health Authority clients can now be processed online through PROVIDERnet for more efficient reimbursements. 

Register for PROVIDERnet to get convenient online access to:

  • check patients’ claim eligibility
  • view fee schedules, predeterminations, and statements

Recent updates for Speech and Language Pathologists in BC: 

Tele-Health

Pacific Blue Cross has been working hard to put in place policies and practices that would enable telehealth services for hearing providers.  As of April 27, 2020, hearing providers can now bill Virtual Care Services to Pacific Blue Cross for those plans with eligible hearing benefits.  Benefits vary from plan to plan. Members should verify benefits coverage for telehealth services for their specific plan. Please note the following requirements:

  • Virtual care can be billed from April 27, 2020 to until further notice.
  • Virtual care must meet all the regulations as outlined by the College of Speech and Hearing Health Professionals of British Columbia, specifically the Virtual Care Standard of Practice.
  • The Audiologist or Hearing Instrument Practitioner providing virtual care services must be licensed to practice in the jurisdiction of member residence.
  • All receipts issued for applicable services must include “Telehealth” in the description.
  • Insta-Claim submissions must indicate “Telehealth” in the nature of illness/injury field for reporting purposes.
Whenever possible, we ask that providers support clients with Pacific Blue Cross coverage by giving them Pre-Authorizations and Assignment of Payment paperwork if the client is unable to pay out-of-pocket for products and services.

Medical Supplies & Equipment Provider

COVID-19 (coronavirus) update for Medical Supply and Equipment Providers

As BC's health benefits society, we want to ensure our members and providers have the tools they need to navigate the most recent developments related to COVID-19 (coronavirus). To stay up to date on the latest information, we recommend that all health providers in British Columbia continue to follow advice from the BC Centre for Disease Control and the government of BC. 

A situation like COVID-19 highlights the many advantages there are for you, our members, and Pacific Blue Cross by capitalizing on the digital capabilities we offer. For the fastest claim turnaround, payment through direct deposit, and to minimize paper and physical mail processing, we encourage you to enable our digital options if you have not yet done so. 

We’d like to remind you that many claims made on behalf of First Nations Health Authority clients can now be processed online through PROVIDERnet for more efficient reimbursements. 

Register for PROVIDERnet to get convenient online access to:

  • Submit Claims
  • view fee schedules, predeterminations, and statements

First Nations Health Authority: 

First Nations Health Benefits is resuming normal service as a part of BC’s Restart Plan.  Each First Nations community is taking a different approach to COVID-19 depending on their circumstances. Providers who wish to travel into a community to deliver services should work closely with the leaders of that community to protect the health and safety of its residents.

Providers are advised to consult their association or college, as well as WorkSafeBC, for information on the health and safety protocols needed to protect providers and patients.

Mental Health Providers

Currently, only psychologists can register for and use PROVIDERnet for Pacific Blue Cross plan members. In November 2021, all psychologists, registered clinical counsellors, certified clinical counsellors, and social workers that provide care to First Nations people and their families through First Nations Health Authority mental health programs will be able to use PROVIDERnet for submitting pre-determination requests and claims.

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