The complete Medavie Blue Cross Provider's Handbook can be found here.
Approved Provider Status
In order for providers to bill for patients covered by IFHP they must first become an IFHP approved provider. Registration form.
Assessing Client Eligibility
Once a client has presented their IFHP form (either an Interim Federal Health Certificate of Eligibility for Refugees or Refugee Protection Claimant Document for Refugee Claimants) the provider must confirm the following:
-
Client matches person in photograph
-
Current validity of IFHP coverage through the secure provider web portal .
-
Even when the presented document indicates that IFHP coverage has not expired, providers MUST verify the current eligibility status since IRCC may have cancelled the client’s IFHP coverage due to a change in their immigration or financial status.
-
Providers must confirm coverage using the Client ID number, which is the eight-digit number that appears in the text box in the upper right-hand corner of the document.
Secure Provider Web Portal and Electronic Claims Submission Service
- Medavie Blue Cross offers a secure provider web portal allowing all registered IFHP provider types to conveniently submit prior approval requests online through the secure provider web portal.
- The electronic claims submissions service enables the provider to pre-determine client eligibility, submit claims with real-time adjudication and confirms the amount to be paid by Medavie Blue Cross.
- To register for this service, please visit the secure provider web portal and complete the online provider portal self-registration form.
-
For billing issues, first contact Medavie Blue Cross at the above number, or email . If issues are unresolved, contact , also available at 1-613-957-5896.
Claim Submission Guideline
The claim submission guideline must be made within 6 months of the service provided.When submitting claims, the following information must be included:
- Client information: name, date of birth, the eight-digit client ID number indicated on the IFHP Certificate of Eligibility or the Refugee Protection Claimant Document.
- Provider information: name, speciality (if applicable), name of referring prescriber (if specialist is claiming the fee), provider number, address, telephone number and fax number.
- Claim information: invoice number (if applicable), date of service, fee code or service provided, ICD code or diagnosis (does not apply to dentists or pharmacists), amount claimed and prior approval, if required.
Fee Policy
- The IFHP fee policy is to reimburse according to provincially/territorially set fee rates for local residents.
- Reimbursement will be made according to the rate in place on the date of service.
- Where provincial/territorial rates for local residents do not exist (i.e., hospital facility fees, etc.), IFHP has developed its own reimbursement rates.
PaymentMedavie Blue Cross will make payment to the Provider or an Assignee (in cases where payment has been assigned to a third party) every second week for the amount due for claims received and adjudicated during the relevant claim period.
- The payment, together with a payment summary detailing all claims submitted during that period, will be mailed directly to the Provider.
- Regardless of the method of payment chosen, a bi-weekly payment summary will be sent by mail for reconciliation purposes. A direct deposit registration form may be printed from the secure provider web portal.
- The Provider will examine and verify the accuracy of the payment summary when received and will notify Medavie Blue Cross in writing of any error or omission within thirty (30) days of its receipt.
Audit Information
- Medavie Blue Cross reserves the right to perform random or annual audits of any Provider billing under this program.
- Upon request, the Provider will make available to Medavie Blue Cross, for audit purposes, the billing and treatment records that detail treatment provided, fees charged and dates of service for IFHP clients, as well as any other documentation that pertains to client information and the Explanation of Benefits (EOB)/claim acknowledgement forms deemed necessary by Medavie Blue Cross to verify claims submitted by the Provider. Such documentation must be signed by the claimant and kept by the Provider for a period of at least two years.
- Providers who submit claims electronically must keep a copy of the “Claims Payment Result Screen” signed by the client/claimant. This document must be kept on file for a period of two years as proof of service for audit purposes.
- Medavie Blue Cross has the right to audit any claim submitted by a Provider, whether that claim has been paid or is outstanding for payment, including claims for which prior approval was obtained.