Starting September 16, 2019, Pacific Blue Cross will become the new third-party hearing benefits administrator for clients of the First Nations Health Authority (FNHA). As of that date, claims and pre-determinations for FNHA clients must be submitted to Pacific Blue Cross rather than Indigenous Services Canada’s Non-Insured Health Benefits (NIHB) program/Express Scripts Canada (ESC).
An Improved Provider Experience
With the transition, Providers will experience:
- A streamlined claims process, including new online claiming capabilities on behalf of FNHA clients;
- Faster reimbursements; and
- A significant reduction in the need for prior approvals.
What’s Changing
Before September 16, 2019
Submit claims to Indigenous Services Canada’s NIHB program/ESC.
On or After September 16, 2019
Submit all claims and pre-determinations to Pacific Blue Cross using the Policy number 40000. Member ID numbers will be the same as FNHA clients’ Status Numbers (clients may show you a Certificate of Indian Status Card or Pacific Blue Cross Member ID card to verify coverage).
What You Need to Do
As a result of this transition, Hearing Providers will have access to PROVIDERnet to process some claims online for FNHA clients and sign up for direct deposit. Paper claim forms for FNHA clients will also be available to submit to Pacific Blue Cross.
Please ensure you register as a Provider with Pacific Blue Cross and sign up for PROVIDERnet prior to September 16, 2019, in order to serve FNHA clients.
For more information, and to learn more about the transition and to review the updated Hearing Provider Reference Guide and a new FNHA Hearing Fee Supplement, visit Pacific Blue Cross online.
If you have any questions or need assistance, please email [email protected].