Government of New Brunswick

Claims submitted by participating providers must include the following information:
 

Field Information Required
Carrier Code NB
Group Number or Code Plan Identification Letter (e.g. ADEFGV)
Patient ID ID number
DIN / PIN DIN or PIN
Prescriber ID Prescriber’s license or registration number (see below)
Prescriber ID Reference Code Code identifying a prescriber’s licensing body (see below)
Drug Cost Please refer to Dispensing Fees and Drug Cost Reimbursement
Mark-up Please refer to Dispensing Fees and Drug Cost Reimbursement
Dispensing Fee Please refer to Dispensing Fees and Drug Cost Reimbursement
 

Prescriber ID and Reference Code

Effective May 3, 2016, prescription claims submitted to the NB Drug Plans must include the prescriber’s license or registration number, as well as the corresponding Prescriber ID Reference Code which identifies the prescriber’s licensing body.

A prescriber’s license or registration number can be obtained by:

A default ID can only be used when:

  • A New Brunswick prescriber’s license or registration number is unknown. Repeated use of default IDs in cases where a Prescriber ID exists will be subject to audit.
  • The prescriber is from out-of-province.

The table below specifies the information required to identify the prescriber.  

 

Prescriber

Field

Location

Type

Prescriber ID

Prescriber ID
Reference Code




New Brunswick

Dentist

License number

45

Physician

License number1

41

Pharmacist

License number

46

Nurse Practitioner

Registration number

48

Optometrist

License number

47



New Brunswick2

(unknown licence or registration number)

Dentist

D1

45

Physician

D3

41

Pharmacist

D5

46

Nurse Practitioner

D7

48

Optometrist

D9

47




Out-of-Province

Dentist

D2




See table

Physician

D4

Pharmacist

D6

Nurse Practitioner

D8

Optometrist

D10

1 A physician’s license number is preceded by two digits and a dash. The two digits represent the year in which the physician was licensed. Do not include these first two digits or the dash in the Prescriber ID field.

2 Repeated use of default IDs in cases where a Prescriber ID exists will be subject to audit. 

 

 

Submission of Claims over $9,999.99

Claims that exceed the maximum claim amount of $9,999.99 must be divided and submitted as separate transactions on the same day. The fewest number of transactions must be used.

Transaction Information
Transaction DIN / PIN Dispensing Fee Quantity Drug Cost Days Supply Copay
First DIN Yes Adjust quantity so that claim cost (including the applicable drug cost, dispensing fee, mark-up) does not exceed $9,999.99 Up to MLP + up to 8%   The amount must correspond to the quantity submitted in each transaction Must correspond with the quantity being submitted in each transaction Adjudication system will deduct copay from the first transaction only  
Second PIN No
Third (if required) PIN No
Fourth (if required) PIN No

Example
Drug Cost:    $22,800 (Up to MLP + up to 8%)
Quantity:       60 tablets
Days Supply:  30 

 

Transaction DIN / PIN Dispensing Fee Quantity Drug Cost Up to MLP + up to 8% Days Supply Copay
First DIN Yes 26 tablets $9,880 13 Yes
Second PIN No 26 tablets $9,880 13 No
Third PIN No 8 tablets $3,040 4 No

The drugs and applicable DINs and PINs that are included in this policy are listed here.

Claims submitted that do not comply with the above requirements are subject to audit and recovery.

 

 

Quantities for Claim Submissions

Correct quantities for various categories of medications and for a number of specific medications are listed here.
 

 

Offline (Manual) Claims

Manual claim forms will be accepted by the New Brunswick Drug Plan from participating providers in the following exceptional circumstances:

  1. Reversal of claims greater than 90 days ago
  2. Resubmission of a claim as a result of a pharmacy audit

Manual Claim Form

 

 

Pharmacy Audits

Payments made that do not comply with these policies are subject to audit and recovery.