Esi Provider Agreement

For more information, visit the Express Scripts Canada Non-Insured Health Benefits Claims Provider (www.provider.esicanada.ca). Indigenous Services Canada`s NiHB (Non-Insured Health Benefits) program and policy information are listed in the following vendor-specific guides: Suppliers wishing to provide services to NIHB customers must register or register with Express Scripts Canada. For more information, please visit the Express Scripts Canada Non-Insured Health Benefits Claims Provider (www.provider.esicanada.ca) website or call the Express Scripts Canada Claims Processing Call Centre at 1-888-511-4666. EmblemHealth requires all Child Health Plus (CHPlus) and Medicaid providers to participate in the Vaccines for Children (VFC) program. The VFC program is a program of the New York State Department of Health (NYSDOH) and the New York City Department of Health and Mental Hygiene (NYCDOHMH) that distributes free vaccines to licensed suppliers who are members of the CHPlus/Medicaid under the age of 19 in New York (Bronx, Kings, New York, Queens, Richmond Countys) and Nassau, Suffolk and Westchester County. Members who meet these criteria are commonly referred to as VFC eligible members. “The provider is not authorized to introduce co-parenting reduction programs for members or otherwise modify a member co-ore, unless such a waiver or rebate is required by law. If [ESI] is aware of a co-parenting or cost-sharing discount offered by the supplier – either by audit, investigation, member statements or verification of the supplier`s website or other advertising material – the supplier may be terminated immediately. All notifications as NIHB providers are subject to verification by the program.

NIHB supplier numbers are processed according to the administrative requirements of the NIHB program. As a supplier, it is important that you read and understand the terms and conditions of the program described in the Claims Submission Kits (www.provider.esicanada.ca). Filing a claim by you shows your understanding and acceptance of the terms and conditions of the NIHB program. Failure by the Supplier to comply with these terms and conditions may result in the suspension or removal of your billing privileges under the NIHB program, as well as all necessary restoration mechanisms. This section outlines policies and procedures for health care providers that cover uninsured health care. It contains information on nihb (non-Insured Health Benefits) policies and lists and refers to claims processing procedures available on Express Scripts Canada`s NiHB Claims Provider website. NIHB`s application procedures are described in claims submission kits on the Express Scripts Canada Non-Insured Health Benefits (www.provider.esicanada.ca) claims providers website. The site also contains claim forms, newsletters, dental money plans and more. Note: EmblemHealth Medicaid members cannot be denied health care because they are unable to pay for co-payment at the time of service. However, suppliers may charge these members or take other steps to recover the amount of the copay owed. Program guidelines and notification/payment information are made available to suppliers via: Please note that the Government of Canada is moving from cheques to direct deposit for all payments made by the government. To receive payments from NIHB, you must register for a direct deposit.

Note that this does not apply to providers who receive payments from Express Scripts Canada. Note: NIHB dental suppliers are 100% financially responsible for all services paid under their supplier number (s), whether they are a partner or owner and/or an owner (principal) at the clinic. EmblemHealth, GHI, HIP and Vytra Commercial Benefits Plans and EmblemHealth Child Plus As a federal government program, the NIHB program must comply with the Data Protection Act, the Canadian Charter of Rights and Freedoms, the Access to Information Act, policies and policies

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