A-29, r. 2 - Regulation respecting hearing devices and insured services

Section 16.1 Disposition versions

2012-09-01

16.1. An insured person, a distributor, a hearing aid acoustician or an institution claiming reimbursement from the Board of the cost of purchase, adjustment, replacement or repair of a hearing device provided or distributed under this Regulation must send, using the form provided by the Board, the following information, which may vary depending on the medium used or depending on whether the case involves a request for special consideration or a claim for payment:

(1)  the health insurance number, the expiration date indicated on the health insurance card and the information required by the Board to identify the insured person who received the property or service;

(2)  the name, dispenser number and, where applicable, permit number of the distributor or institution, and the name, member number in the Ordre des audioprothésistes du Québec and dispenser number of the hearing aid acoustician who provided the property or the service described, as well as the reference number of the request for special consideration or the claim for payment;

(3)  the hearing loss in each ear assessed according to the conditions provided for in this Regulation, and the information contained in the medical certificate referred to in subparagraph a of subparagraph 1 of the first paragraph of section 6 and in subparagraph 1 of the first paragraph of section 7, and, in the case of a request for special consideration;

(4)  the date the impression was made and the date of service;

(5)  the code for the good or service, side of the body, type, the code for the apparatus allocated, the reference code for the apparatus, the serial number, the number of units, the amount claimed, the date on which the property was allocated or the service rendered and, where applicable, the reason for replacement;

(6)  the indicator for the program referred to in the claim for payment;

(7)  a statement by the insured person confirming that the person received the property or service described and authorizing the Board to make the payment;

(8)  the necessary information for identifying the recipient of the payment; and

(9)  a statement by the hearing aid acoustician or the distributor confirming that the information provided is accurate and complete.

O.C. 1090-2011, s. 3.