A-29, r. 7.2 - Regulation respecting the terms and conditions for the issuance of health insurance cards and the transmittal of statements of fees and claims

Section 9.1 Disposition versions

2018-06-28

9.1. (Revoked).

O.C. 1756-92, s. 2; O.C. 1522-96, s. 1; O.C. 659-2018, s. 5.

2012-09-01

9.1. Every pharmacist entitled to remuneration by the Board for insured services must transmit to the Board a claim for payment or a statement of fees containing the following elements:

(1)  a control number identifying each claim for payment or each statement of fees submitted to the Board;

(2)  the insured person’s health insurance number and the sequential number of his health insurance card or, where applicable, his name at birth, date of birth and sex;

(3)  where applicable, the insured person’s relationship to the health insurance card holder;

(4)  where applicable, the code of the program to which the claim for payment or statement of fees is related;

(5)  where applicable, the code identifying a specific group of insured persons;

(6)  the pharmacy number;

(7)  the dispensing pharmacist’s number;

(8)  the prescriber type, the prescriber number and, where applicable, the initials of his first and last names;

(9)  where applicable, the number of the designated pharmacy contacted;

(10)  the prescription number, the service code and, where applicable, the intervention or exception code describing a specific situation or service;

(11)  where applicable, an indication that the prescription is a new prescription or a refill, the code indicating whether the prescription is a written or a verbal prescription, the number of authorized refills, the last date on which the prescription is valid, and the duration of the treatment;

(12)  where applicable, the medication code or supplier code, an indication to the effect that the pharmacist has dispensed an equivalent medication or that the prescriber has indicated not to substitute, the quantity dispensed, the source of supply, the acquisition format number, and the type of magistral medication;

(13)  the date of dispensation of the professional service;

(14)  the amount of the fees claimed, by type of service, and, where applicable, the amount charged for the medication or service;

(15)  where applicable, the transaction date of the cancelled claim for payment or cancelled statement of fees, and its control number;

(16)  the signature of the pharmacist covered by the agreement or the signature of his duly authorized mandatary or his identification code where the statement of fees or claim for payment is transmitted by interactive electronic means.

O.C. 1756-92, s. 2; O.C. 1522-96, s. 1.