Information for Providers of Incontinence Supplies
Questions and Answers
What changes are being made to incontinence supplies under the NIHB Program?
- A national price file and benefit codes are being implemented for select incontinence supplies (adult diapers and disposable liners).
- These changes will come into effect on September 1, 2012.
Why was the price file created?
The NIHB Program created the price file to guide the administration of requests for incontinence supplies. The price file reflects a reasonable price including a mark-up comparable to the usual and customary pricing for these items. An allowance has been made for clients living in the territories to accommodate for higher costs.
Please note: The prices in this price file do not apply to specific providers with existing contracts for incontinence products.
How was this price file determined?
The price file was determined by reviewing all prices paid by the NIHB Program for these select incontinence supplies in each region. This data was supplemented by manufacturers' pricing catalogues, the price points set by other public/private health care plans, and industry group consultations.
Why were new benefit codes created for adult diapers?
New benefit codes were created to more accurately describe the size and type of adult diapers being requested.
|Item Name||Item Number||Provinces||Territories|
|ADULT DIAPERS/PULL-UPS, Small or Medium||99401087||$1.24||$1.42|
|ADULT DIAPERS/PULL-UPS, Large or Extra Large||99401088||$1.33||$1.52|
|ADULT DIAPERS/PULL-UPS, XXX Large||99401089||$1.51||$1.73|
|ADULT DIAPER /TABS, Small or Medium||99401090||$0.99||$1.13|
|ADULT DIAPER /TABS, Large or Extra Large||99401091||$1.21||$1.39|
|ADULT DIAPER /TABS, XXX Large||99401092||$1.43||$1.63|
This information is also available on the Health Canada website at: www.healthcanada.gc.ca/nihb
How do I submit claims for clients with an existing prior approval for these incontinence supplies?
Providers are advised to submit their claims using the code(s) referenced in the prior approval confirmation letter.
On September 1, 2013, the old codes for these incontinence supplies will be discontinued.
Requests for prior approval received on/after September 1st, 2012
- Use the new codes and prices to avoid the prior approval request being denied.
What if a client requires a size that is not listed or more incontinence supplies than what the NIHB Program covers?
For clients who require a size that is not listed, or more incontinence supplies than what the Program regularly covers, the prior approval request must be supported with a prescription stating the medical need/justification.
Where can I find information on incontinence supplies covered by the NIHB Program?
The Medical Supplies and Equipment Benefit List provides a description of the incontinence supplies covered by the NIHB Program, along with information pertaining to benefit codes, requirements for prior approval, and applicable frequency limitations. It is available on the Health Canada website at: http://www.healthcanada.gc.ca/nihb
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