The ages at which benefits cease for a dependent child (i.e., 18, 19, Learn More Ontario Drug Programs Reference Manual Drug Programs Delivery Branch Drugs and Devices Division Ministry of Health NOVEMBER 27, 2019 REVISION #1 - APRIL 1, 2020 Really. GJ Non-formulary drug - maximum allowable unit drug cost exceeded & Some groups remain with ESC; complete migration to TELUS Health by Q1 2020. GSC is a health benefits provider. Adjudication Response Codes • Standard Canadian Pharmacists Association response codes are attached to a claim when it is returned by PharmaNet, providing information on the status of the claim. 2035 0 obj <>/Filter/FlateDecode/ID[<90F2961177340D47B0C648261DBA853E><7CD48DA61694CC47A6B53B5E8ED349AF>]/Index[2027 17]/Info 2026 0 R/Length 57/Prev 372808/Root 2028 0 R/Size 2044/Type/XRef/W[1 2 1]>>stream �ꇆ��n���Q�t�}MA�0�al������S�x ��k�&�^���>�0|>_�'��,�G! Green Shield Canada (GSC) Maintenance Medication Fill Limits . DA, DB, DE intervention codes “DA” and “DB” intervention codes are used for coordinating a claim between two (2) payers (or drug plans). INTRODUCTION TO GREEN SHIELD CANADA . This CPhA Pharmacy Claim Standard (CPhAPCS) Standard was developed by the Canadian Pharmacists Association (CPhA) to provide orderly and efficient online processing of prescription drug claims. An intervention code of “NH - Initial Code 77401 can only be reported once per treatment session regardless of the number of sites treated. You must indicate one of the following carrier codes for each claim: CARRIER CODE 12: To be used for all Government of Alberta Human Services claims. 1193 0 obj <>/Filter/FlateDecode/ID[<680961424DB3134A8CB310117C71D4DA>]/Index[1176 28]/Info 1175 0 R/Length 86/Prev 95653/Root 1177 0 R/Size 1204/Type/XRef/W[1 2 1]>>stream Express Scripts Canada is a leader in health benefits management. @� ��) • GP actions/does not action change and returns form(s) to the pharmacy • Pharmacists will be reimbursed on seeking agreement to the change and making the recommendation to the GP. Green Shield Canada is committed to inclusivity and providing accessible information and communications. GSC has discount arrangements with select providers across Canada. Clinical Vignettes. CARRIER CODE 16: To be used for Compensation Plan for Pharmacy Services and Alberta Public Health Activities Programs claims. Green Shield Canada Days Maintenance Medication Fill Limits - Feb 1, 2016 Dear Members: As you may be aware, effective February 1, 2016, Green Shield Canada (GSC) has limited the number of fills to five per year for a defined list of maintenance drugs. .07 SCHEDULE TYPE This field is a set of codes and will be used as a default value when selecting this drug in order entry. L \����2\�^�7��PQ?XE��n -��P* �X �l�uo�\�h� ��� GH Non-formulary drug - maximum allowable unit drug cost exceeded . may. H��TMo�@�ﯘ�]�����Z�"ŐTTBe�P��*�����ή ��{�]{�ۙ7�#�ͺY�ʪ�����i��y������^�cZ�_�hEufHE- ��̂T3���~��y�5������Rn�r�X�͢^��u��I{�� 0�M�"�s8��2 �?�Q2 ���[�b��$﹆M�ߟv�o��y�S�}�ؽ&��4à����͝f�ϻ�������YUw�l/�s�UN�T0�HC����>��DO�X��95�s��sɻ�r֝��S������ }__m��dT�������D���u��Cl\b���[λ�|����%�M��(è�4�L��)y�z�_q��"3a���*����$,�k2�e���}EDŽ�Sˍ����QUa-$�"�t ���V� If the documentation of the use of the intervention code is recorded on the pharmacy’s computer system, auditors require access to the pharmacy's computer system. CARRIER CODE VL: To be used for Veterans Affairs Canada claims. "@3��$��A,v�^ � $&t201��Y����F� 0 P�. ♦ Pharmacy Charges for Hospice Recipients ... • Codes 77402 through 77416 are limited to three per day. h��Vmo�0�+��_lj4Mj� CARRIER CODE 12: To be used for all Government of Alberta Human Services claims. DA = Secondary claim, first payer was a provincially sponsored plan. Initial medication therapy assessment and intervention is performed. The online adjudicator for green shield Canada is ProviderConnect. ... intervention, with or without quantitative measurement of gallbladder function) �� Easy claiming. between seven to 27 days using the Special Service Code (SSC) “2” to receive a full dispensing fee. a copy of the provincial program’s decision letter to the pharmacy directly – not to GSC. Message: “DR = days’ supply lower than minimum allowable.”. h�bbd``b`��� B�-[�W4HLH������^d100�&��z� � �� NIHB’s 7-day short term dispense policy will continue to be in effect. Insurance Lingo Dictionary. Add-on code 99607 is reported in addition to codes 99605, 99606 for each additional fifteen minutes of service beyond the initial service. But, as a social enterprise we are more than what we do. Initial Days Supply for New Prescriptions. A different kind of health benefits company. The ages at which benefits cease for a dependent child (i.e., 18, 19, 21 or 25) vary for cardholders with family coverage. Check out the list below. This form may be obtained by contacting the Manitoba Pharmaceutical Association or the DPIN Help Desk at 789-8000. endstream endobj 1177 0 obj <. Green Shield Canada’s (GSC’s) biosimilar strategy: developed in 2016 With biologic drugs as one of the fastest growing areas in pharmaceutical development (and drug spend), GSC has been at the forefront of industry discussions around the growing body of evidence supporting safe and effective transitioning of … 2. Use of this intervention code is subject to audit. Examples include: Note: The TELUS Health pharmacy manual and pharmacy updates form part of the provider agreement. h�b```�^VI``��0p\ r6��h�?&�(`��p;wPLh�=4�Pс�P�"~(f`Tҫ��0F�N�\������y���3��|� IP: 199.71.241.21. Claim is rejected with response codes: QO - Preference or step drug available or Green Shield Canada Intervention Codes. endstream endobj 2028 0 obj <>/Metadata 105 0 R/PageLayout/OneColumn/Pages 2019 0 R/StructTreeRoot 156 0 R/Type/Catalog>> endobj 2029 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 2030 0 obj <>stream In most cases, your pharmacy can bill your drug plan directly. The most current versions are available on our web site. Drug. Pharmacy providers can apply an intervention code but should only do so for a valid medical rea-son when an intervention has been conducted. Check out the list below. %%EOF Code DUR Description Action Supported Intervention Codes D2 DIN/PIN/GP # is discontinued Reject - No override Allowed D7 Refill too soon Override Allowed MG Override - Various Reasons MR Replacement, item lost or broken UF Patient gave adequate explanation. CARRIER CODE VL: To be used for Veterans Affairs Canada claims. If you have any questions, please contact the Express Scripts Canada Provider Claims Processing Call Centre at … (Source: Pharmacy Claims Submission Kit, Section 7 .4.1 . ��w�G� xR^���[�oƜch�g�`>b���$���*~� �:����E���b��~���,m,�-��ݖ,�Y��¬�*�6X�[ݱF�=�3�뭷Y��~dó ���t���i�z�f�6�~`{�v���.�Ng����#{�}�}��������j������c1X6���fm���;'_9 �r�:�8�q�:��˜�O:ϸ8������u��Jq���nv=���M����m����R 4 � GG Non-formulary drug - maximum allowable unit drug cost exceeded - check unit drug cost . Green Shield Canada (GSC) is a not-for-profit corporation federally registered by the Office of the Superintendent of Financial Institutions. It is designed to serve the needs of pharmacists and drug benefit plan administrators to the benefit of their patients and clients. Click Concurrent DUR, Intervention Suite, Formulary Info Sheet or Generic Drugs on left panel.. NexSys is a safe and secure system that can process prescription drug claims in real time. 00999997) a valid compound code must be provided as per the CPhA standard (a numeric value between 0 and 9) if the pharmacy is claiming a compounding charge in addition to the normal professional fee. Refer to the Compounding section of the Guide for current compound codes. Most information and questions pertaining to their policies can be found in the ProviderConnect pharmacy provider guide. PharmaCare requires pharmacists to document the reason for the use of an intervention code in a manner accessible for audit purposes. If, in the pharmacist’s professional judgement, an early refill is required, NIHB will reimburse for these claims. If you require an accessible communication format or support to use this site, or if you have any feedback on how we can make this site more accessible for persons with disabilities, please click here or contact customer.service@greenshield.ca.