When does administration of vision benefits for FNHA clients transition to Pacific Blue Cross?
The transition of vision benefits takes place on September 16, 2019. As of September 16, the FNHA asks all Vision Care 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.
How do I process claims prior to the transition date?
Please continue to submit claims to FNHA prior to the transition on September 16.
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 register through PROVIDERnet at pac.bluecross.ca/provider prior to September 16 in order to process claims on behalf of FNHA clients. PROVIDERnet gives you access to a host of convenient account management features, including online claiming capabilities for FNHA clients and Pacific Blue Cross Members.
Registering for PROVIDERnet is quick and easy.
Make sure to have your office name and address information as well as practitioner details on hand before you begin.
- Visit pac.bluecross.ca/provider
- Select New Providers
- Select Vision
- Under Account Management, select Register for a NEW provider location
- Fill out the online PROVIDERnet 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.
What is PROVIDERnet?
PROVIDERnet is an efficient online claim management tool from Pacific Blue Cross that offers real-time information, including immediate confirmation of coverage, which can be shared with clients at point of sale. Visit pac.bluecross.ca/provider to learn more.
Which Vision Providers are eligible to register for PROVIDERnet?
Pacific Blue Cross registers the following Provider Types for PROVIDERnet:
- Optical Stores
What are the benefits of using PROVIDERnet?
- Quick, easy, and secure
- Patient convenience and satisfaction
- Reduced credit card fees with direct deposit from Pacific Blue Cross
- Convenience of real-time processing
Is there a charge for using PROVIDERnet?
Access to PROVIDERnet is free for all Providers.
What do I need to register as a Vision Provider?
To be eligible to register as a Vision Provider, you will need to have one licensed Optometrist or Ophthalmologist in your clinic. Optical stores must provide a copy of their city business license.
How long does it take to register for PROVIDERnet?
The initial online registration takes less than five minutes. Following online registration, processing may take up to 5 business days. It is not necessary to submit more than one application. Once processed and approved, you will receive an email confirmation with login information.
Which plans can I submit claims for on PROVIDERnet?
At this time, you can submit claims through PROVIDERnet for Pacific Blue Cross Members and FNHA clients (as of September 16, 2019) only. If you are registered and have signed up for direct deposit, all claims payable to you will be deposited into your bank account.
What is my Pacific Blue Cross issued Provider ID number?
If you have already signed up for PROVIDERnet, your Provider ID will be available in the Claims section after you log in at pac.bluecross.ca/provider. Choose Claim Statements in the dropdown list to find your ID number. If you have not yet signed up for PROVIDERnet, please visit pac.bluecross.ca/provider and submit a registration application. Pacific Blue Cross will issue you a Provider ID after reviewing your application.
What is the difference between a Primary Account Administrator and a Standard Account Administrator in PROVIDERnet?
- A Primary Account Administrator is a person who has access to add/edit banking information and who also has access to submit an electronic claim through PROVIDERnet.
- A Standard Account Administrator is a secondary account to the Primary Administrator account. They can submit claims on the Primary Administrator’s behalf; they do not have the ability to update banking information or view claim statements.
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.
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.
You cannot submit a claim on PROVIDERnet until you have entered in your direct deposit information.
Please note: To ensure privacy and security, Pacific Blue Cross staff cannot set up direct deposit information.
Claims Processing Information – For First Nations Health Authority (FNHA) client claims after September 16, 2019
How do I check a client's benefit coverage through PROVIDERnet?
To check a client's eligibility through PROVIDERnet, you can submit a claim to check the coverage amounts and then reverse it immediately.
Some plans may have specific claiming requirements. The response message you receive on PROVIDERnet after submitting a claim will indicate if this benefit requires additional criteria to support adjudication (e.g. doctors note or pre-authorization). For more information, please refer to the Vision Provider Reference Guide at pac.bluecross.ca/provider.
How do I reverse a claim made through PROVIDERnet?
The option to reverse a claim made through PROVIDERnet is found in the Claims menu; simply select the Claim History/Claim Reversal option. Search for the claim you wish to reverse and then click on the Details option. From there you can select Reverse Claim. Please note, you have one year from the date of service to reverse a claim.
What is Assignment of Payment?
Assignment of Payment (AOP) is a service that Pacific Blue Cross offers on an exception basis for reimbursement plans to clients with financial hardship, or for plans that do not allow Pay Provider relationships (expense must exceed $1,000). Download the AOP form on PROVIDERnet at pac.bluecross.ca/provider.
Do I need my patient's authorization to submit claims on their behalf using PROVIDERnet?
Yes, you will require a patient's authorization to submit claims on their behalf using PROVIDERnet. Download the Pay Provider Authorization Form found on PROVIDERnet at pac.bluecross.ca/provider and complete all required information prior to providing the goods and/or services. You must receive one Pay Provider Authorization Form per client/dependent prior to submitting a claim on their behalf. This form only needs to be completed once, however it must be kept on file for a minimum of three (3) years from the last date of claim submission made on the client's behalf.
When will I get paid?
Payment cut off is every Friday at midnight and cheques are printed and mailed every Monday. Electronic Funds Transfers (EFTs) are released every Monday and should be in your account no later than Wednesday.
Can you re-issue me a new/replacement cheque?
Cheques can be reissued/replaced three weeks after original issue date. Please contact Pacific Blue Cross at 604-419-2000, or toll-free at 1-877-722-2583, Monday to Friday between 8:00 am - 4:30 pm to request a reissue/replacement cheque.
What is the benefit of direct billing on behalf of FNHA clients?
By submitting claims directly to Pacific Blue Cross, you will save your clients time and allow them to avoid out-of-pocket expenses at the time of sale. Online billing allows Providers simpler record keeping processes and financial tracking.
Which mailing address should I use to send in my paper claims or pre-authorizations?
To mail in claims for Pacific Blue Cross Members and First Nations Health Authority clients, please use the following address:
Pacific Blue Cross
PO Box 7000
Where can I find Pacific Blue Cross paper claim forms?
You can download Pacific Blue Cross paper claims forms from PROVIDERnet at pac.bluecross.ca/provider. Please note: If you have an FNHA or a MSDPR client, please ensure you choose the appropriate claim form.
Which date do I record for the service date?
The service date refers to the date on which the item is dispensed or the date on which the services were provided.
Where can I get a copy of my claim statement?
If you have signed up for PROVIDERnet and have direct deposit, your claim statements will be available in the Accounts section once you've logged in. If you do not have a PROVIDERnet account, your claim statement will be mailed to you directly. If you need a copy of a previously issued claims statement, please contact Pacific Blue Cross to have one mailed to you.
Why was my claim rejected?
For claims submitted by paper, the remittance statement issued to you by mail will have detailed responses explaining why the claim was rejected. For claims submitted electronically, an immediate response message will display detailing the rejection explanations.
What documents should I keep on file for Audits?
During a retailer audit, Pacific Blue Cross will audit all records and documentation relevant to the identified claims submissions, billing and payment for services and supplies. These can include, but are not limited to:
- Manufacturer and wholesaler invoices;
- Prescription records and associated documentation;
- Relevant inventory management records;
- Any other record that is relevant to claims submissions, billings and payments.
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.