NIHB Audit Support

NIHB Audit ToolKit for Saskatchewan Pharmacies

To support pharmacist being audited, PAS created an NIHB Audit Toolkit for Saskatchewan Pharmacies booklet that contains support on how to get ready for an audit, the most commonly audited items and how to appeal audited items.

NIHB Audit ToolKit

The Toolkit is intended to support, assist and prepare PAS member pharmacists with the audit of NIHB beneficiary prescriptions by:

  • Highlighting key points within the NIHB Pharmacy Claims Submission Kit the Express Scripts Pharmacy Provider Agreement and the NIHB Pharmacy Guide for Pharmacy Benefits.
  • Reviewing prescriptions for validity as required by pharmacy practice standards in the province of Saskatchewan.
  • Suggesting audit prevention measures.
  • Providing an audit preparation checklist.
  • Including relevant websites and documents dedicated to NIHB audit recovery prevention.

This document is only available to Association members.

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NIHB Audit Program

The NIHB provider audit program ensures that the NIHB Program is accountable for the expenditure of public funds. The Health Information and Claims Processing Services (HICPS) contractor performs this audit function by verifying paid claims against pharmacy records to confirm that the claims have been billed in compliance with the terms and conditions of the NIHB Program.

Detailed information about audit procedures and the responsibilities of pharmacy providers for these audits are included in section 8.0 of the Pharmacy Claims Submission Kit.

Co-ordination of Benefits

Persons eligible for the NIHB Program are required to access any public or private health plan or provincial/territorial programs for which they are eligible before accessing NIHB. Pharmacy providers must confirm with each client whether other coverage exists because a claim must be submitted to the other party first for processing. Once this party processes the claim, the provider may then submit to NIHB for payment.

Claims submitted for NIHB clients who no longer have coverage with another plan must be supported by a letter from the client or from the provider on behalf of the client.

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