Insurances and Claims
Guidelines
This section will explore how to complete various insurance claims, such as WSCC, Blue Cross, Quebec out-of-province claims, and out of country claims.
Out of Country Claims
These claims include self pay
Once the registration officer collects and makes a copy of the necessary information, such as the patient health insurance and coverage and the identification cards or passport, they should be sent together with the out-patient report or inpatient report to the Medical Billing Department for further invoicing where the Medical Billing Officer will create a Doctor’s Claim Card to accompany those information and direct them to the Finance Directorate.
Qikiqtani General Hospital Quebec Out-of-Province Claim
Quebec Specific
Before the patient is seen by the physician, they must complete the out of province Quebec claim’s form as they have to enter their information and the patient has to sign the form. Once the physician completes the information and signs the document, all the documents, i.e. out- patient report and/or inpatient report, and the signed of out of province form should be directed to the Medical Billing Department for further coding and invoicing. Once it is complete, the medical billing officer will then direct the document to Finance Directorate for final invoicing.
Blue Cross
RCMP / Department of National Defense Claim Forms
The RCMP / National Defense (Military) Claims process starts with either the Physician or Nurse inputting the patient information and the identification card into the Blue Cross form in addition to out-patient and/ or inpatient reports when the patient was seen at the ER.
The Physician or the nurse then signs the Blue Cross document and forwards it to the Medical Billing Department where the Medical Billing Officer enters the coding and amount of the claim, makes a copy and sends it out to Finance Directorate for final invoicing.
WSCC (WCB in the South)
The Workers’ Safety & Compensation Commission
The WSCC claims reimbursement process starts with the original WSCC form that is completed by a physician or nurse, with or without out of patient report/inpatient report, received by the Medical Billing Department and the medical billing officer who then creates an internal invoice to accompany the claim before it is sent to the Government of Nunavut’s Finance Directorate for the Department of Health and Social Services.
The Finance Directorate then creates the final billing, submits it for signing, and sends the whole package to WSCC for final reimbursement.
WSCC Forms
Details & Instructions
Part of the WSCC formal forms issued by WSCC that are part of the original document that should be submitted to Medical Billing Department for further processing include:
First Medical Report
Medical Progress Report
Hand Injury Report
Eye Injury Report
These forms should be completed by a physician or nurse directly with detailed information pertaining to the injury, detailed patient information such as their name, address, date of birth, and employer’s name. Medical Billing Officers cannot complete this form on behalf of the physician or nurse as WSCC will reject the claim.
Please make sure to complete or answer the entire questionnaire within the form as, if it is incomplete, WSCC will most likely reject the claim.
If the patient was seen at the ER, please attach the green copy of the out-patient report together with the claim as a package and forward to the Medical Billing Department.
If the patient was seen at the clinic or in the community health centre, please submit only the WSCC form that was filled either by the nurse or by physician.
Only one form needs to be completed or is allowed per 24 hours period per patient as the WSCC will only reimburse one claim per patient per day.
Blue Cross
Common Forms
Below is the list of Blue Cross Forms that can be used for each specific situation:
RCMP
Outpatient Services
Medical Services
Nursing Services
Hospital Services
Ambulance Services
National Defense
Hospital Services
Claim Form for Programs 6 & 12
Claim Form for Programs 1,7,9,11,12,13 & 14 only
Out Patient Services
Most of the case we only use the Outpatient Services form and Medical Services form.
Quebec Out-of-Province Claim
Please make sure that all of the information regarding the patient, including their address in Quebec and not their local Iqaluit address along with their Quebec health card number and expiry date are recorded.
Once those are completed, both the physician and patients need to sign the form otherwise Quebec will refuse to reimburse the claim.
Instructions
Out of Country Claim and Self Pay
Please make a copy of patient information such as passport, driver’s license, and health insurance card with their insurance policy number and send to Medical Billing Department for further invoicing.
Intructions