When does administration of benefits for FNHA clients transition to Pacific Blue Cross?
The transition of benefits takes place on September 16, 2019. As of September 16, the FNHA asks all MS&E 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 for Pharmacy Providers will be posted on pac.bluecross.ca/provider prior to September.
How do I process claims prior to the transition date?
Please continue to submit claims as usual prior to the transition on September 16. Please do not delete First Nations Status Numbers from patient profiles. The Status Number will be the Member ID number for First Nations clients under Pacific Blue Cross.
What actions do I need to take to prepare for the transition on September 16?
This will be a new plan for FNHA clients in partnership with Pacific Blue Cross, and set-up will require changes to your Practice Management software:
- Pharmacies servicing FNHA clients will need to update the patient information in their software systems to show Pacific Blue Cross as the Carrier (Carrier ID: E1).
- Pharmacies wanting to submit MS&E items for FNHA patients will be required to update their software to use PharmaCare and/or Pacific Blue Cross PINs for claims submission. Please note, you will need to include PINs that Pacific Blue Cross will issue for new MS&E items. To update your system:
- Contact your software vendor if you receive centralized updates; or
- Manually configure your software as per your usual business practice.
This information is also intended to support pharmacists in the event they receive a client without NIHB or Plan W coverage as of September 16. Standard processes for submitting Plan W claims will not change.
As of September 16, 2019, the FNHA asks all pharmacies providing MS&E items 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. MS&E claims submitted to Indigenous Services Canada’s Non-Insured Health Benefits (NIHB) program on or after September 16 will be rejected as a non-eligible benefit.
I have never registered as a Provider with Pacific Blue Cross – will I need to do that before the transition?
Yes; If you have not already done so, you must register as a Provider with Pacific Blue Cross prior to the transition on September 16, 2019, in order to process benefits on behalf of FNHA clients. As a Provider you will also have access to register for PROVIDERnet, Pacific Blue Cross’s online claim management system.
Registering as a new Provider is quick and easy.
Make sure to have a current copy of your operating permit, your Pharmacy accreditation number and the name of the business owner available before you begin.
- Visit pac.bluecross.ca/provider
- Select New Providers
- Select Pharmacy
- Under Account Management, select Register for a NEW account with Pacific Blue Cross.
- 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.
I am a small independent pharmacy, is there anything specific I need to know during the transition of FNHA benefits from NIHB to Pacific Blue Cross that will impact me directly?
Please contact your software vendor immediately to enable your software to support the Pacific Blue Cross Carrier Code for FNHA Clients.
My pharmacy software is not connecting to Pacific Blue Cross automatically for FNHA clients, how can I fix this?
Please contact your software vendor to enable FNHA clients to be attached to the Pacific Blue Cross Carrier Code.
I am a software vendor; how can I support pharmacies in submitting claims on behalf of FNHA clients during the transition?
Please contact Provider Relations at Pacific Blue Cross at firstname.lastname@example.org for more information and detailed instructions.
Claims Processing Information – For First Nations Health Authority (FNHA) client claims after September 16, 2019
How do I submit claims on behalf of FNHA clients?
All pharmacies need to be registered with Pacific Blue Cross to submit Drug and Medical Equipment Claims on behalf of FNHA clients. Please visit pac.bluecross.ca/provider and apply to become a Pacific Blue Cross Pharmacy Provider.
How do I submit Medical Supplies and Equipment claims on behalf of FNHA clients?
The FNHA Pharmacy Fee Supplement details which Medical Supplies and Equipment supplies can be submitted electronically by pharmacies (Pharmacy Fee Supplement available by September 2019 at pac.bluecross.ca/provider). Each product will have a Pseudo Identification Number (PIN) for ease of transmission through the CPhA Claims Standards.
Will the NIHB codes for MS&E stay the same? If not, how will these new codes be communicated to pharmacies?
No; the new system will use standard Pacific Blue Cross codes for MS&E benefits. These codes will be published on the Pacific Blue Cross website at pac.bluecross.ca/provider prior to September 16, 2019.
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 Eligibility Unit. Please note: For privacy reasons, Pacific Blue Cross cannot provide a client's ID number to a third party.