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 (see below)
Patient ID Patient’s Plan ID number or Medicare number (see below)
Patient Code (NB Drug Plan only)
Patient’s ID number (see below)
Patient Name
Patient’s first and last name
Patient Date of Birth
Patient’s date of birth
Prescriber ID Prescriber’s license or registration number (see below)
Prescriber ID Reference Code Code identifying a prescriber’s licensing body (see below)
Drug DIN or PIN
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

Backdating and resubmission of electronic claims is permitted within 90 days of the dispensed date. Reimbursement of manual claims will be considered by the New Brunswick Drug Plans in the following exceptional circumstances:

1.     For reversal of claims greater than 90 days ago

2.     Resubmission of a claim as a result of a pharmacy audit

Manual claims must be submitted to the New Brunswick Drug Plans using the Manual Claim Form.
 

Group Number or Code and Patient ID

The table below specifies the information required to identify the Group Number or Code and Patient ID.

Plan

Group Number
or Code

Patient ID

New Brunswick Prescription Drug Program (NBPDP)

 

 

Seniors

A

Plan ID Number

Social Development Clients

F

Plan ID Number

Adults in Licensed Residential Facilities (Special Care Homes)

E

Plan ID Number

Children in the Care of the Minister of Social Development and Special Needs Children

G

Plan ID Number

Nursing Home Residents

V

NB Medicare Number

Cystic Fibrosis

B

Plan ID Number

Growth Hormone Deficiency

T

Plan ID Number

HIV/AIDS

U

NB Medicare Number

Multiple Sclerosis

H

Plan ID Number

Organ Transplant

R

Plan ID Number

 

 

 

The New Brunswick Drug Plan

D

Plan ID Number

Other Government Sponsored Plans

 

 

Medical Abortion Program

J

NB Medicare Number

Pharmacist Administered
Publicly Funded Seasonal
Influenza Vaccine

I

NB Medicare Number

Tuberculosis

P

NB Medicare Number*

Extra-Mural Program Clients

W

NB Medicare Number

For out of province patients, please refer to the NB Drug Plans Policy Manual.
 

 

Prescriber ID and Reference Code


Effective May 3, 2016, prescription claims submitted to the New Brunswick 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

Midwife

Registration number

99



New Brunswick2

(unknown license or registration number)

Dentist

D1

45

Physician

D3

41

Pharmacist

D5

46

Nurse Practitioner

D7

48

Optometrist

D9

47

Midwife

D11

99




Out-of-Province

Dentist

D2




See table

Physician

D4

Pharmacist

D6

Nurse Practitioner

D8

Optometrist

D10

Midwife

D12

99

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.
 

 

Methadone for the Treatment of Opioid Use Disorder


  • In addition to the claim submission requirements outlined above, the unit of measure (quantity) for billing compounded methadone oral solution claims is milligrams. For example, a 70 mg dose of methadone should be billed with a quantity of 70.
  • A maximum of one claim per beneficiary is permitted per day.

 

Designated High Cost Drugs


To reduce the potential for wastage, claims for designated high cost drugs that require special authorization (SA) are subject to a maximum days supply (e.g. 30 days) when administered at standard doses. The SA drugs which this applies to are identified in the Maximum Allowable Price (MAP) List and Manufacturers List Price (MLP) List at Drug Price Lists and Pricing Policy.
 

 

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

Mark-Up

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. The amount must correspond to the quantity submitted in each transaction

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  

Subsequent transactions

PIN

No

 

 

 

 

 

 

Example
Drug Cost:       $24,000 (Up to MLP)
Mark-Up:         $1,920 (Up to 8%)
Quantity:         60 tablets
Days Supply:  30 

 Transaction

DIN / PIN

Dispensing Fee

Quantity

Drug Cost

Up to MLP

Mark-Up

Up to 8%

Days Supply

Copay

First

DIN

Yes

23 tablets

$9,200

$736

12

Yes

Second

PIN

No

23 tablets

$9,200

$736

11

No

Third

PIN

No

14 tablets

$5,600

$448

7

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


Please refer to the Maximum Allowable Price (MAP) List and Manufacturers List Price (MLP) List at Drug Price Lists and Pricing Policy to confirm the correct quantity for claim submissions for a specific product.
 

 

Pharmacy Audits


All claims submitted to the Plans for reimbursement are subject to audit and recovery. Additional information regarding audit and recovery is available on the Pharmacy Provider Audit webpage.