FAQ: Ministry of Social Development and Poverty Reduction—Digital management of vision pre-determinations and claims

As the benefits administrator for the Ministry of Social Development and Poverty Reduction (MSDPR), we are excited to announce that Pacific Blue Cross will be offering electronic pre-determination and claims functionality for vision products and services for MSDPR clients.

  1. What is changing?

    We will be offering electronic pre-determination and claims processing for vision products and services for MSDPR clients. This functionality will go live in late winter, 2021.

  2. Why are you making these changes?

    Through automation we can provide better service, help to streamline your administration of MSDPR clients, reduce your claims handling costs, and turn pre-determination confirmations and benefits claims around faster.

  3. I’m a vision provider. How will these changes affect me?

    If you are registered for PROVIDERnet and direct deposit with Pacific Blue Cross, you will have the ability to process most product or service pre-determinations, as well as submit most benefits claims electronically on behalf of MSDPR clients. Plus, the direct deposit set-up ensures reimbursements from all Pacific Blue Cross plans are paid right into the bank account you set up on PROVIDERnet.

    Check this space in the next few weeks as we provide more details about the impact this change will have on you and your business processes.

    If you are not registered for PROVIDERnet, we encourage you to sign up now to streamline pre-determinations and claims processing.

  4. Will reserves continue to be done for vision care benefits?

    As of the launch date, we will no longer be processing reserves for MSDPR clients by phone. We’ll be retiring the telephone reserve process and replacing it with the online pre-determination process.

  5. Are pre-determinations required for an MSDPR client’s claim to be processed?

    Yes. To secure eligibility and payment, all claims for vision products and services submitted on behalf of MSDPR clients must have an approved pre-determination (or pre-authorization, if required) on file to be processed for reimbursement.

    NOTE: Services requiring pre-authorizations will be processed by mail or fax. The pre-authorization outcome will be available in PROVIDERnet.

  6. Will I be able to call the Client Service Centre to request a pre-determination after this new functionality is operational?

    No. There will be two options to obtain a pre-determination for a vision care benefit: submit it electronically using PROVIDERnet or mail/fax us a paper-based pre-determination form.

  7. What happens if I have submitted a reserve request prior to the launch of the new electronic processes in PROVIDERnet?

    If you have Vision reserves on file, you will have to submit the claims manually using the updated form available on www.providernet.ca. We encourage you to submit a pre-determination to replace any reserves you already have on file to ensure that the client’s services will be covered and that you can submit claims on their behalf.

    NOTE: Existing reserves will expire 30 days after the launch date, after which you’ll be required to submit a new pre-determination via PROVIDERnet or mail/fax.

  8. Can I still send claims in manually?

    Yes.

  9. Can I still fax you the completed pre-determination forms?

    Yes. However, pre-determination outcomes will be mailed to you. If you have registered for PROVIDERnet, you’ll also be able to view the outcomes online.

  10. How do I sign up for PROVIDERnet?

    Detailed instructions on how to sign up for PROVIDERnet are available in the Vision Provider Reference Guide found on pac.bluecross.ca/provider.

  11. Which vision products and services are covered for MSDPR clients?

    Pacific Blue Cross will continue to follow the MSDPR Optical Fee Schedules. Please review these documents to understand the coverage levels. Some codes in the fee schedules will change to better identify service to right and left eyes.

  12. 12. When will you provide more specific information about this transition?

    Keep watching this space—we’ll be updating our resources and posting them as we get closer to the go-live.