Non-Insured Health Benefits transitions to ESI Canada
To: First Nations Leadership & Health Directors
November 26th, 2009
Non-Insured Health Benefits Program transitions to ESI Canada
Joint Communique NIHB Transfer | pdf download |
Effective December 6, 2009 Health Canada’s Non-Insured Health Benefits Program (NIHB) will be moving to a new claims processor. The new claims processor, ESI Canada, takes over from First Canadian Health (FCH).
ESI Canada will administer the Health Information and Claims Processing Services (HICPS) System for pharmacy, dental and medical supplies and equipment (MS&E) benefits on behalf of Health Canada’s NIHB Program. The responsibility encompasses all aspects of benefits processing and payment of claims and extends to verification, audit and recovery where deemed appropriate. All current health service providers are expected to enrol with the new claims processor.
To date dental providers representing 90 per cent of claims and pharmacies representing 63 per cent of claims have signed on with the new provider. Health Canada has extended the deadline for other service providers to sign on until March 31, 2010.
“We are working to ensure as smooth a transition as possible, and with the extended deadline we envision few interruptions in service.” said Yousuf Ali, Regional Director of First Nations and Inuit Health, BC Region.
Concerns have been raised that some providers may not sign on leading to gaps in service for some communities.
Joe Gallagher, CEO of the First Nations Health Council, comments “We are aware that concerns are being raised about continuity of service through this transition period. These services providers are not legislated by any government to claim through the NIHB program. These service providers are governed by a code of ethics where they must provide services but it is up to them how they wish to be paid leaving clients to get reimbursed by their specific benefit plans. Ultimately we cannot force providers to sign on.”
Michelle DeGroot, VP Policy and Advocacy for the First Nations Health Council adds, “Service providers may decide not to continue with the NIHB program, but will risk a drop in income for not providing this service to First Nations.”
This issue was encountered several years ago when pharmacists were refusing services in an effort to negotiate higher rates for drug dispensing. Health Canada was able to find other pharmacists to ensure service was delivered in a prompt manner to First Nations in BC.
Both the First Nations Health Council and First Nations Inuit Health, BC Region are working with professional associations such as pharmacists, to resolve outstanding issues. Communities are encouraged to talk to their local service providers in advance of the new March 2010 deadline to ensure continuity of service.
For questions related to the change in claims processor, please contact:
Tara Bjornson, Manager, non-Insured Health Benefits: 604-666-3990