Billing Guidelines & FAQs
Q: What is the billing process for patients covered under IFHP?
A: The IFHP provides several options for providers to determine whether the service or product is covered or not under the IFHP, depending on their type (hospital, doctor, pharmacists, etc.) or their specialty/profession (general practitioner, psychiatrist, optometrist, etc.). Claims can be mailed, faxed or submitted electronically to Medavie Blue Cross with the applicable information.
- Health-Care Professionals − Secure Provider Web Portal and Electronic Claims Submission: Medavie Blue Cross offers a secure provider web portal allowing hospitals, medical doctors, nurses, audiologists and other eligible health service providers to conveniently verify their patient’s eligibility, submit claims (7 a.m. to 12 a.m. seven days per week) or prior approval requests (24/7) online. This portal enables them to pre-determine client eligibility for specific treatment and, depending on their specialty, submit claims with real-time adjudication and confirmation of the amount to be paid by Medavie Blue Cross.
- Pharmacies − Pharmacy Claims for Point of Sale (POS) Claims Transmissions: Pharmacy providers can verify coverage for specific drugs and submit claims electronically to Medavie Blue Cross through Pharmacy Claims for Point of Sale (POS) Claims Transmissions. A beneficiary’s eligibility can be verified through the IFHP Secure Provider Web Portal.
- Dentists - can verify coverage for specific treatment and send claims electronically through CDAnet, DAcnet or Reseau ACDQ to Medavie Blue Cross. A beneficiary’s eligibility can be verified through the IFHP Secure Provider Web Portal.
Certain claims are not available for electronic submission, and providers must contact the Medavie Blue Cross Call Centre or submit claims/special authorization requests by mail or fax.
Paper claim forms can be downloaded from the secure provider web portal or by faxing a request to Medavie Blue Cross. Paper claims can be faxed to 506-867-3841 or mailed to:
Interim Federal Health Program
Medavie Blue Cross
644 Main St. PO Box 6000
Moncton, NB E1C 0P9
For more information on claim submission guidelines, please consult IFHP Information Handbook for Health Care Professionals or visit the Medavie Blue Cross site for health-care providers.
Q: I am a primary care physician working in a FHO, and I have recently taken on a large refugee family. Visits so far have been at least 45 minutes per person at a time, as everything goes through a translator and multiple family members with multiple medical concerns. Most of these issues would normally be billed as an A007 but each issue is taking upwards of 30 minutes to sort on its own. Any ideas for billing these visits?
A: One could bill the A911A, if it is a minimum of a 50-minute visit. This billing code is a "Special Family and General Practice Consultation" billed at $144.75 (out-of-basket). If there is counselling, for example: counselling patients on medical issues, one could bill the K013A code (in-basket) paid at $62.75 for 1.4 units, and then one could bill the K040A code $62.75 (out-of-basket) which is a "group counselling, per unit, where no group member received more than 1.4 units of K013A or K040A in 12 months. If the "Group" has had more than 1.4 units of K013A or K040A per 12 months, then one would bill the K041A code (out-of-basket) - $38.80.
There is also an A912A code that is billed for a "comprehensive family and general practice consultation" and needs to be a minimum of 75 minutes paid at $217.15 (out-of-basket).
For more information on the billing codes above, click on this resource: Billing & Payment Guide for Family Health Organization (FHO) Physicians – Opting for Solo Payment.