Government of New Brunswick

Claims submitted by participating providers must include the following information:

Field Information Required
Carrier ID NB
Group Number or Code Plan Identification Letter (see below)
Client 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 DOB 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)
DIN / PIN Drug Identification Number / Product Identification Number
Quantity Quantity dispensed
Days Supply Number of days’ supply dispensed (see below)
Drug Cost / Product Value Please refer to Dispensing Fees and Drug Cost Reimbursement
Cost Upcharge Please refer to Dispensing Fees and Drug Cost Reimbursement
Professional 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.
 


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
Correctional Facilities C Client Information System (CIS) 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
Pharmacy Administered Publicly Funded Vaccines, Testing and Drug Therapies Program 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.
 


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

99

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.

Repeated use of default IDs in cases where a Prescriber ID exists will be subject to audit.tification d’un prescripteur existe, fera l’objet d’une vérification.
 


All claims submitted to NB Drug Plans must have the correct number of days’ supply for the dispensed quantity of drug. Related policies are listed below:

Maximum Days’ Supply

All claims submitted to the plans for reimbursement are subject to a maximum days’ supply. Details are outlined in the Maximum Days’ Supply Policy.

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. Details are outlined in the Designated High Cost Drug Policy.

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.

Frequency of Dispensing and Payment

This policy establishes criteria for dispensing drugs taken continuously (long-term). Details are outlined in the Frequency of Dispensing and Payment Policy.
 


Claims that exceed the maximum claim amount of $9,999.99 must be divided and submitted as separate transactions on the same day. The first transaction must use the DIN and contain the drug cost, mark-up and dispensing fee. The subsequent transactions must use the PIN, contain drug cost, applicable markup, and be submitted with Intervention and Exception Code “MG”. The fewest number of transactions must be used.

Transaction Information
Transaction DIN/PIN Dispensing Fee Quantity Drug Cost Mark-Up Days Supply Copay Intervention and
Exception Code
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  
Leave Blank
Subsequent transactions PIN No MG

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 Intervention and
Exceptiion Code
First DIN Yes 23 tablets $9,200 $736 12 Yes Leave Blank
Second PIN No 23 tablets $9,200 $736 11 No MG
Third PIN No 14 tablets $5,600 $448 7 No MG

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.
 


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.

The unit of measure (quantity) for billing methadone for the treatment of opioid use disorder is milligrams. For example, a 70 mg dose of methadone should be billed with a quantity of 70.
 


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.