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To our Providers,

As BC’s health benefits society, the safety and welfare of our employees and members is of paramount importance.

In light of ongoing developments resulting from the COVID-19 (coronavirus) pandemic—and out of a concern for the health and wellbeing of our members and staff—Pacific Blue Cross will temporarily close our walk-in centre to the general public as of Monday, March 16th. We apologize for any inconvenience this closure might cause.

Rest assured: We are operational.

We are striving to ensure our members and providers continue to receive the services and support you require. For the fastest claim turnaround, we encourage you to enable our digital options if you have not yet done so.

  • Register for PROVIDERnet through our “Manage Your Account” section. You can:
    • check patients’ claims eligibility
    • submit Insta-Claims
    • view fee schedules, predeterminations, and statements
    • get paid by direct deposit
  • Are you an Insta-Claim Provider? Let your patients know!
    • Providers registered to submit electronic claims through PROVIDERnet are visible to 1.6 million Pacific Blue Cross members through our Insta-Claim directory.

To keep you and your family safe, healthy and informed on COVID-19, we encourage you to visit the Government of Canada’s coronavirus information. For more local information, go to the BC Centre for Disease Control or your local health authority website. Pacific Blue Cross also has a COVID-19 Resource Centre on our website.

We will continue to follow the local health authorities’ recommended approach for prevention and protection. And we’ll keep you informed of any updates.

Healthy Wishes,

John D. Crawford
President and Chief Executive Officer
Pacific Blue Cross

Provider News

Telehealth: Claims submission guidelines

Wednesday, May 20, 2020

Pacific Blue Cross has been working hard to establish policies and practices that allow eligible providers (including psychology, chiropractic, physiotherapy, and hearing) to claim telehealth services. 

New! Online Access to Pre-Determination Results

Friday, Nov 15, 2019

If you submit pre-determination requests to Pacific Blue Cross, you will now be able to get your responses faster than before.

Provider Updates: First Nations Health Authority (FNHA) Benefits - September 2019

Sunday, Sep 15, 2019

Starting on September 16th, 2019, Pacific Blue Cross will administer benefits on behalf of clients of the First Nations Health Authority (FNHA) in British Columbia for dental, vision, hearing, medical supplies and equipment, and drugs not covered by BC PharmaCare Plan W.

More Articles

Dental Providers

COVID-19 (coronavirus) update for Dental 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 Dental Providers in BC 

  • Temporary updates have been made to the 2020 Pacific Blue Cross Dental Fee Schedule to support Tele-health services for patient consultations. We encourage you to download the most recent version of our 2020 Pacific Blue Cross Dental Fee Schedule at providernet.ca. Coverage may vary by plan.

Get the additional information from the CDSBC, including a list of frequently asked questions, at: https://www.cdsbc.org/Pages/covid-19-info.aspx

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:

Pacific Blue Cross COVID-19 (coronavirus) Action Plan Update

To our Dental Providers,

As BC’s health benefits society, the health and wellbeing of our members and employees is our top priority. We also recognize the role Pacific Blue Cross plays in the healthcare of our members. Given these unique and uncertain times, we have created a COVID-19 Resource Centre  that we are constantly updating. As the situation surrounding COVID-19 (coronavirus) continues to evolve, we want to do our part to ensure the safety and welfare of our community.

COVID-19 is proving to be a great test for us all, but rest assured we continue to operate, just differently. We are following recommendations from the government and health authorities to protect the safety of our employees who serve our clients and members. To support social distancing guidelines and those staying home following travel, we have begun to work remotely.

Our precautionary measures to fight the spread of the virus will have impacts as we deliver our plan:

  • Paper claims, calls and emails will be temporarily delayed.
  • Calls and claims for those covered by the Ministry of Social Development and Poverty Reduction and Children and Families will be prioritized.
  • Call and claims for those covered by the First Nations Health Authority will be prioritized.
  • Payment cheques and direct deposit payments continue to be processed.
  • Continue to send documents such as x-rays to support pre-authorizations
  • Electronic claims continue without interruption.

We also ask that you help us fight the spread of COVID-19.  By removing paper-based transactions from our business we can encourage social distancing, ensure continuous benefits and help the environment. Please process all claims that you can for members electronically through your software.

For even more digital assets sign up to PROVIDERnet to check patients’ claim eligibility, view fee schedules, pre-determinations, process emergency dental claims for the Ministry of Social Development and Poverty Reduction, electronic banking and online statements.  It’s as easy as:

  1. Select “Registration/Acct Management” below and choose your preferred method

We also understand the vital role you play in the healthcare ecosystem, connecting members to their benefits. Understandably, you have questions for us during this unique time. We will keep this page updated with answers or you can email provider@pac.bluecross.ca.

We will continue to follow the recommended approach from the local health authorities for protection and prevention.  And we’ll keep you informed of any updates.

Healthy Wishes,

John D. Crawford
President and Chief Executive Officer
Pacific Blue Cross

I acknowledge that I have the honour of working on the traditional territory of the Coast Salish Peoples, specifically the shared traditional territories of the Sḵwx̱wú7mesh Úxwumixw (Squamish), Tsleil-Waututh, xʷməθkʷəy̓əm (Musqueam) and Kwikwetlem First Nations.

 

Pharmacy Providers

COVID-19 (coronavirus) update for Pharmacy 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 Pharmacy Providers in BC:

Visit the College of Pharmacists of British Columbia website to learn more about recommendations and guidelines.

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:

  • view fee schedules and statements
  • get claims paid through electronic funds transfer

First Nations Health Authority

Update to Fax line for Claims Submission

Current Practice: Claims that cannot be submitted electronically through the Pharmacy software or through PROVIDERnet for Medical Supply and Equipment providers must be submitted by Paper. Fax claims submission is only accepted for rush claims to support emergency situations. 

Temporary Practice Change: Pacific Blue Cross will accept all Medical Supply and Equipment claims that cannot be submitted electronically by fax at 604.677.0277 for Pharmacies or Medical Supply and Equipment Providers. 

We appreciate the urgency of requests; we process claims in submission order. Duplicate claims will not be processed faster.

This temporary practice change will be in place for a period from March 30th until further notice

Wound Care | Update to Wound Care Assessment Form Submission Frequency

Current Practice: For clients requiring additional wound care above $200 for Group 2, providers should submit the FNHA Wound Care Assessment Form, a pre-determination, and a copy of the prescription/recommendation to Pacific Blue Cross for review.

Pacific Blue Cross requires the client to submit a monthly updated FNHA Wound Care Assessment Form unless otherwise indicated on the pre-determination.

The FNHA Wound Care Assessment Form is required to support clients with advanced wound care needs. Pacific Blue Cross will provide the client with additional dollars for wound care supplies to appropriately meet the wound care plan.

Temporary Practice Change:   Pacific Blue Cross requires the client to submit an updated FNHA Wound Care Assessment form every two months.

This temporary practice change will be in place for a three-month period from March 30th through June 30th, 2020.

As of July 1, 2020, this temporary practice change has ceased, and Wound Care Assessment Forms are required monthly.

Pacific Blue Cross COVID-19 (coronavirus) Action Plan Update

To our Pharmacy Providers,

As BC’s health benefits society, the health and wellbeing of our members and employees is our top priority. We also recognize the role Pacific Blue Cross plays in the healthcare of our members. Given these unique and uncertain times, we have created a COVID-19 Resource Centre  that we are constantly updating. As the situation surrounding COVID-19 (coronavirus) continues to evolve, we want to do our part to ensure the safety and welfare of our community.

COVID-19 is proving to be a great test for us all, but rest assured we continue to operate, just differently. We are following recommendations from the government and health authorities to protect the safety of our employees who serve our clients and members. To support social distancing guidelines and those staying home following travel, we have begun to work remotely.

Our precautionary measures to fight the spread of the virus will have impacts as we deliver our plan:

  • Paper claims, calls and emails will be temporarily delayed.
  • Pharmacy related calls will be prioritized.
  • Calls and claims for those covered by the Ministry of Social Development and Poverty Reduction and Children and Families will be prioritized.
  • Call and claims for those covered by the First Nations Health Authority will be prioritized.
  • Prescription medications will follow recommendations by the Ministry and BC College of Pharmacists with Pharmacists following the Pacific Blue Cross Pharmacy Reference Guide.
  • Payment cheques and direct deposit payments continue to be processed.
  • Electronic claims continue without interruption.

We also ask that you help us fight the spread of COVID-19.  By removing paper-based transactions from our business we can encourage social distancing, ensure continuous benefits and help the environment. Please process all claims for members electronically.

For even more digital assets sign up to PROVIDERnet to view fee schedules, electronic banking and online statements.  It’s as easy as:

  1. Select “Registration/Account Management” below and choose your preferred method

We also understand the vital role you play in the healthcare ecosystem, connecting members to their benefits. Understandably, you have questions for us during this unique time. We will keep this page updated with answers or you can email provider@pac.bluecross.ca.

We will continue to follow the recommended approach from the local health authorities for protection and prevention.  And we’ll keep you informed of any updates.

Healthy Wishes,

John D. Crawford
President and Chief Executive Officer
Pacific Blue Cross

I acknowledge that I have the honour of working on the traditional territory of the Coast Salish Peoples, specifically the shared traditional territories of the Sḵwx̱wú7mesh Úxwumixw (Squamish), Tsleil-Waututh, xʷməθkʷəy̓əm (Musqueam) and Kwikwetlem First Nations.

 

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:

  • Chiropractic Tele-Health services can be billed for subsequent visits from March 24 to until further notice
  • Chiropractic Tele-Health services can be billed for initial visits from April 27 to until further notice.
  • 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.
  • Tele-Health services provided by Chiropractors will be available to all Pacific Blue Cross Members with Chiropractic benefits for a temporary period, without precedence
  • Pacific Blue Cross will issue an updated statement to outline future benefit coverage options after the period has expired.
  • All receipts issued must include “Tele-health” for these services.
  • Insta-Claim submissions must indicate “Tele-health” in the nature of illness/injury field for reporting purposes.
  • 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:

  • Physiotherapy Tele-Rehabilitation can be billed for subsequent visits from March 24 to until further notice
  • Physiotherapy Tele-Rehabilitation services can be billed for initial visits from April 27 to until further notice.
  • 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.  
  • Tele-Health services provided by Chiropractors will be available to all Pacific Blue Cross Members with Chiropractic benefits for a temporary period, without precedence
  • Pacific Blue Cross will issue an updated statement to outline future benefit coverage options after the three month period has expired.
  • All receipts issued must include “Tele-rehabilitation” for these services.
  • Insta-Claim submissions must indicate “Tele-rehabilitation” in the nature of illness/injury field for reporting purposes.
  • 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.

 

Pacific Blue Cross COVID-19 (coronavirus) Action Plan Update

To our Extended Health and Vision Care Providers,

As BC’s health benefits society, the health and wellbeing of our members and employees is our top priority. We also recognize the role Pacific Blue Cross plays in the healthcare of our members. Given these unique and uncertain times, we have created a COVID-19 Resource Centre  that we are constantly updating. As the situation surrounding COVID-19 (coronavirus) continues to evolve, we want to do our part to ensure the safety and welfare of our community.

COVID-19 is proving to be a great test for us all, but rest assured we continue to operate, just differently. We are following recommendations from the government and health authorities to protect the safety of our employees who serve our clients and members. To support social distancing guidelines and those staying home following travel, we have begun to work remotely.

Our precautionary measures to fight the spread of the virus will have impacts as we deliver our plan:

  • Paper claims, calls and emails will be temporarily delayed.
  • Calls and claims for those covered by the Ministry of Social Development and Poverty Reduction and Children and Families will be prioritized.
  • Payment cheques and direct deposit payments continue to be processed.
  • Electronic claims continue without interruption.

We also ask that you help us fight the spread of COVID-19.  By removing paper-based transactions from our business we can encourage social distancing, ensure continuous benefits and help the environment. Please process all claims for members electronically and direct bill with insta-claims by signing on to PROVIDERnet on our website. You can also check patients’ claim eligibility, view fee schedules, predeterminations and statements.

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

For medical equipment, 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.

We also understand the vital role you play in the healthcare ecosystem, connecting members to their benefits. Understandably, you have questions for us during this unique time. We will keep you updated through this page or you can email provider@pac.bluecross.ca.

We will continue to follow the recommended approach from the local health authorities for protection and prevention.  And we’ll keep you informed of any updates.

Healthy Wishes,

John D. Crawford
President and Chief Executive Officer
Pacific Blue Cross

I acknowledge that I have the honour of working on the traditional territory of the Coast Salish Peoples, specifically the shared traditional territories of the Sḵwx̱wú7mesh Úxwumixw (Squamish), Tsleil-Waututh, xʷməθkʷəy̓əm (Musqueam) and Kwikwetlem First Nations.

 

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.

Pacific Blue Cross COVID-19 (coronavirus) Action Plan Update

To our Extended Health and Vision Care Providers,

As BC’s health benefits society, the health and wellbeing of our members and employees is our top priority. We also recognize the role Pacific Blue Cross plays in the healthcare of our members. Given these unique and uncertain times, we have created a COVID-19 Resource Centre  that we are constantly updating. As the situation surrounding COVID-19 (coronavirus) continues to evolve, we want to do our part to ensure the safety and welfare of our community.

COVID-19 is proving to be a great test for us all, but rest assured we continue to operate, just differently. We are following recommendations from the government and health authorities to protect the safety of our employees who serve our clients and members. To support social distancing guidelines and those staying home following travel, we have begun to work remotely.

Our precautionary measures to fight the spread of the virus will have impacts as we deliver our plan:

  • Paper claims, calls and emails will be temporarily delayed.
  • Calls and claims for those covered by the Ministry of Social Development and Poverty Reduction and Children and Families will be prioritized.
  • Payment cheques and direct deposit payments continue to be processed.
  • Electronic claims continue without interruption.

We also ask that you help us fight the spread of COVID-19.  By removing paper-based transactions from our business we can encourage social distancing, ensure continuous benefits and help the environment. Please process all claims for members electronically and direct bill with insta-claims by signing on to PROVIDERnet on our website. You can also check patients’ claim eligibility, view fee schedules, predeterminations and statements.

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

For medical equipment, 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.

We also understand the vital role you play in the healthcare ecosystem, connecting members to their benefits. Understandably, you have questions for us during this unique time. We will keep you updated through this page or you can email provider@pac.bluecross.ca.

We will continue to follow the recommended approach from the local health authorities for protection and prevention.  And we’ll keep you informed of any updates.

Healthy Wishes,

John D. Crawford
President and Chief Executive Officer
Pacific Blue Cross

I acknowledge that I have the honour of working on the traditional territory of the Coast Salish Peoples, specifically the shared traditional territories of the Sḵwx̱wú7mesh Úxwumixw (Squamish), Tsleil-Waututh, xʷməθkʷəy̓əm (Musqueam) and Kwikwetlem First Nations.

 

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: 

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.

Update to Fax line for Claims Submission

Current Practice: Claims that cannot be submitted electronically through the Pharmacy software or through PROVIDERnet for Medical Supply and Equipment providers must be submitted by Paper. Fax claims submission is only accepted for rush claims to support emergency situations. 

Temporary Practice Change: Pacific Blue Cross will accept all Medical Supply and Equipment claims that cannot be submitted electronically by fax at 604.677.0277 for Pharmacies or Medical Supply and Equipment Providers. 

We appreciate the urgency of requests; we process claims in submission order. Duplicate claims will not be processed faster.

This temporary practice change will be in place for a period from March 30th until further notice.

Wound Care | Update to Wound Care Assessment Form Submission Frequency

Current Practice: For clients requiring additional wound care above $200 for Group 2, providers should submit the FNHA Wound Care Assessment Form, a pre-determination, and a copy of the prescription/recommendation to Pacific Blue Cross for review.

Pacific Blue Cross requires the client to submit a monthly updated FNHA Wound Care Assessment Form unless otherwise indicated on the pre-determination.

The FNHA Wound Care Assessment Form is required to support clients with advanced wound care needs. Pacific Blue Cross will provide the client with additional dollars for wound care supplies to appropriately meet the wound care plan.

Temporary Practice Change:   Pacific Blue Cross requires the client to submit an updated FNHA Wound Care Assessment form every two months.

This temporary practice change will be in place for a three-month period from March 30th through June 30th, 2020.

As of July 1, 2020, this temporary practice change has ceased, and Wound Care Assessment Forms are required monthly.

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  • Save on credit card fees
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