FNHA Benefits Transition: Frequently Asked Questions for Dental Providers

On September 16, Pacific Blue Cross will become the new third-party dental benefits administrator for First Nations Health Authority (FNHA) clients. As of that date, claims for FNHA clients must be submitted to Pacific Blue Cross rather than Indigenous Services Canada’s Non-Insured Health Benefits program (NIHB)/Express Scripts Canada (ESC).

Transition Information

  1. When does administration of dental benefits for FNHA clients transition to Pacific Blue Cross?

    The transition of dental benefits takes place on September 16, 2019. As of September 16, the FNHA asks all Dental Providers to please submit claims to Pacific Blue Cross using the Policy number 40000. Member ID numbers for FNHA clients match their Status Numbers. Clients may show you a Certificate of Indian Status Card or Pacific Blue Cross Member ID card to verify coverage.

    A new fee supplement and updated reference guide will be posted on pac.bluecross.ca/provider prior to September.

  2. How do I process claims prior to the transition date?

    Please continue to submit claims to NIHB/ESC as usual leading up to September 16.

  3. What actions do I need to take to prepare for the transition on September 16?

    If you have not registered as a Provider with Pacific Blue Cross, please do so prior to September 16 in order to process claims on behalf of FNHA clients. After registering as a Provider, you will be able to register online for Pacific Blue Cross’s convenient online claims management system, PROVIDERnet. Visit pac.bluecross.ca/provider to register.

    Registering as a Provider is quick and easy.

    Make sure to have your unique 9-digit number (UIN) assigned by the CDA/DAC/CDHA, your 4-digit office number assigned by the CDA/DAC/CDHA, as well as your office address on hand before you begin.

    1. Visit pac.bluecross.ca/provider
    2. Select New Providers
    3. Select Dental
    4. Under Account Management, select Register for a NEW account with Pacific Blue Cross.
    5. Fill out the online Provider application.

    You will receive an email confirmation upon completing the online form that your application has been received (processing may take up to 5 business days) and you’ll be ready to activate your account.

Provider Registration/PROVIDERnet

  1. What is PROVIDERnet?

    PROVIDERnet is an efficient online claim management tool from Pacific Blue Cross that allows Dental Providers the ability to upload their direct deposit information, check eligibility, view pre-authorizations, access claim statements and download helpful guides and resources.

  2. What are the benefits of using PROVIDERnet?
    • Quick, easy, and secure
    • Claim payments directly deposit into your bank account
    • Online claim statements
    • Access to updated user guides and supplements
  3. Is there a charge for using PROVIDERnet?

    Access to PROVIDERnet is free for all Providers.

  4. Who is eligible to register for PROVIDERnet?

    To register for PROVIDERnet, you must be a:

    • Dentist
    • Denturist
    • Independent Hygienist

    To be eligible as a Dental Provider you will need to know your 9-digit UIN number assigned by CDA/DAC/CDHA and your 4-digit office number assigned by CDA/DAC/CDHA.

  5. How long does it take to register for PROVIDERnet?

    The initial online registration for PROVIDERnet takes less than five minutes. After your initial online registration, processing of your account may take up to five business days. Please note: It is not necessary to submit more than one application. Once processed and approved, you will receive an email confirmation with your login information.

  6. What is the difference between a Primary Account Administrator and a Standard Account Administrator in PROVIDERnet?
    • A Primary Account Administrator is the dental practitioner who has access to add/edit banking information, as well as view pre-authorizations and claim statements. The Primary Administrator can also set up another Primary Administrator if they choose to grant someone else that main role (i.e. office manager) or other Standard Administrators (front desk staff).
    • A Standard Account Administrator is a secondary account to the Primary Administrator account. They have access to eligibility, claim statements and pre-authorizations, but do not have access to view or change banking information.
  7. How do I add a Standard Account Administrator?

    The Primary Administrator can set up a Standard Administrator when logged in to PROVIDERnet:

    • Sign in to your account at pac.bluecross.ca/provider
    • Select Account > Administer User Accounts > Create New User Account
    • Enter First Name, Last Name and the email address of the person you want assigned to that role.
    • Select Role: Primary Administrator or Standard.
  8. What is my Provider ID?

    Your Provider ID is the 4-digit office number assigned to you by the CDA/DAC/CDHA, or a 4-digit number Pacific Blue Cross has assigned to your office.

  9. I am having trouble signing into PROVIDERnet, who do I contact for help?

    If you have not signed in for six months or longer, your PROVIDERnet account will be considered inactive. To reactivate your account, please contact Pacific Blue Cross directly at 604-419-2000, or toll-free at 1-877-722-2583, Monday to Friday 8am - 4:30pm.

    If you cannot remember your PROVIDERnet account password, you can request a password reset. The temporary password will be sent to the email on file and will expire after 24 hours.

  10. How do I upload my direct deposit information in PROVIDERnet?

    Once you've registered for PROVIDERnet and are logged in, you'll find the option for direct deposit. You will need your bank transit, institution and account number to complete your direct deposit request. Dental Providers can choose to add different bank account information for each location at which they are working.

    Please note: To ensure privacy and security, Pacific Blue Cross staff cannot set up direct deposit information. This is a self-serve function only.

Claims Processing Information – For First Nations Health Authority (FNHA) client claims after September 16, 2019

  1. Will the process for submitting dental claims, Pre-Determinations, and treatment plans for FNHA clients change?

    Yes. Dental Service Providers will check coverage for FNHA clients through the Pacific Blue Cross system as of September 16. Pre-Determinations and treatment plans will also be processed and adjudicated by Pacific Blue Cross, based on FNHA’s new plan design. Claims can be transmitted using your existing software.

  2. How will I know if a BC First Nations client is covered under the new plan?

    Client eligibility is determined by FNHA. FNHA clients who received their benefits under the NIHB program will be automatically enrolled on the new plan under Pacific Blue Cross, effective September 16, under Pacific Blue Cross policy number 40000. Group Plan ID numbers will be matched to Status Card numbers. As of September 16, you will need to contact FNHA at 1-855-550-5454 (extension 2 for other inquiries, followed by extension 1 for the Eligibility Unit).

  3. My office submitted a Pre-Determination or treatment plan to NIHB for a service scheduled after September 16. Will we need to re-submit or will it be transferred to the new plan?

    For the few services where a Pre-Determination is required, the Pre-Determination will be transferred to Pacific Blue Cross. If you experience any issues during this process, please contact Pacific Blue Cross, or attach a copy of the Pre-Determination with your claim.

  4. We submitted a Pre-Determination on behalf of an FNHA client prior to September 16, and it was denied. Should we re-submit after September 16?

    Yes. Approvals for Pre-Determinations under the new FNHA Dental plan may be different. As Pacific Blue Cross is streamlining the approval process for efficiency, some services will no longer require a Pre-Determination.

  5. Will Pre-Determinations issued before September 16 be paid at the NIHB rate or the Pacific Blue Cross Fee Schedule/Supplement rate, if the treatment is performed after September 16?

    Claims processed as of September 16 will be reimbursed at the rate listed in the Pacific Blue Cross dental fee schedule/supplement.

Benefits Information - For FNHA client claims after September 16, 2019

  1. How do we find out which services are eligible under the new plan?

    Details of the new FNHA benefits plan with Pacific Blue Cross will be made available on the Pacific Blue Cross website. As of September 16, Dental Service Providers can sign in to PROVIDERnet at pac.bluecross.ca/provider to check FNHA client coverage online.

  2. What will be included in FNHA's Dental Accident Coverage?

    FNHA clients will have Pacific Blue Cross' Standard Dental Accident Coverage as outlined in the Dental Fee Schedule.

  3. Will dental reimbursement rates change with the transition to PBC?

    As of September 16, reimbursement rates for dental coverage for FNHA clients will align with the Pacific Blue Cross Fee Schedule. Plan details will be available for clients on the Pacific Blue Cross website through their Member Profile account (pac.bluecross.ca), or the Pacific Blue Cross Mobile App (visit pac.bluecross.ca/mobile for details), and for Providers on pac.bluecross.ca/provider.

  4. Will there be improved coverage for dentures?

    Yes. There will be improved coverage in the new plan in terms of coverage and frequency for dentures and partial dentures. Details of the new plan design will be communicated prior to September on pac.bluecross.ca/provider, including a reference guide and fee supplement.

  5. If I have questions about the new FNHA benefits plan for dental, who should I contact for information?

    Leading up to September 16, please contact FNHA at 1-855-550-5454. Once the new plan is launched through Pacific Blue Cross on September 16, Providers may contact PBC, as they do for all other enquires, at 1-604-419-2000 or toll-free at 1 877 PAC-BLUE.

  6. What if my client does not know their ID number?

    As of September 16, the client will need to contact the FNHA at 1-855-550-5454 to speak with the FNHA Eligibility Unit. Please note: For privacy reasons, Pacific Blue Cross cannot provide a client's ID number to a third party.