NIHB Direct Billing Guide for Therapists & Counsellors

Once you're enrolled as an NIHB Mental Health Counselling Provider, you can bill eligible counselling services directly through the Non-Insured Health Benefits (NIHB) Program.

Direct billing allows eligible First Nations and Inuit clients to receive approved counselling services without paying out of pocket, while providers receive payment directly through Express Scripts Canada.

This guide explains the complete billing process—from confirming eligibility to receiving payment.

Step 1: Confirm You're an Enrolled NIHB Provider

Before submitting any claims, you must be enrolled with the NIHB Mental Health Counselling Program.

Once approved, you'll receive:

• Your NIHB Provider Number
• Access to the NIHB Provider Web Account
• Eligibility to submit Prior Approval requests
• Eligibility to bill approved counselling services

Your Provider Number is linked to your approved practice location. If your practice information changes, you'll need to update your provider profile.

Step 2: Verify Client Eligibility

Before providing counselling, confirm that your client is eligible for NIHB mental health benefits.

You'll generally verify:

• NIHB identification or Status number
• Client's legal name
• Date of birth
• Current benefit eligibility

Because NIHB is the payer of last resort, ask whether the client has any other health insurance coverage. If they do, that plan is generally billed first before NIHB covers the remaining eligible costs.

Verifying eligibility before the appointment helps avoid claim delays later.

Step 3: Understand Prior Approval

The first 2 hours of counselling can generally be provided without prior approval, allowing you to complete an assessment and begin treatment.

If additional sessions are clinically indicated, you'll submit a Prior Approval request through the NIHB system outlining the client's treatment needs.

Once approved, NIHB issues a Prior Approval (PA) number, which must be included when submitting claims for approved counselling sessions.

Keeping track of approved hours helps prevent billing errors and claim rejections.

Step 4: Provide the Counselling Service

Deliver counselling according to your treatment plan, professional standards, and the approved NIHB authorization.

As the provider, you're responsible for:

• Obtaining informed consent
• Maintaining complete clinical documentation
• Providing services within your scope of practice
• Ensuring services match the approved authorization

Good documentation supports continuity of care and helps verify claims if they're reviewed in the future.

Step 5: Submit Your Claim

Most providers submit claims electronically through the secure NIHB Provider Web Account.

Electronic submission offers several advantages:

• Faster claim processing
• Immediate claim status information
• Electronic adjudication responses
• Online access to payment information

Paper claims are available in limited situations but are generally used less frequently.

Using the online portal helps simplify the billing process and reduce administrative delays.

Step 6: Review Your Claim Statement

After your claim has been processed, you'll receive a Claim Statement through your Provider Web Account or according to your communication preferences.

Your statement will show:

• Approved claims
• Payments issued
• Claims requiring correction
• Response or rejection codes (when applicable)

Reviewing claim statements regularly helps identify billing issues early and reduces the need for future corrections.

Step 7: Receive Payment

Approved claims are generally paid by direct deposit every two weeks.

Payments are deposited according to the banking information on your provider profile.

Keeping your banking information current helps prevent payment interruptions.

Keep Your Provider Information Current

Notify NIHB whenever your practice information changes.

Examples include:

• Practice address
• Business name
• Telephone number
• Email address
• Banking information
• Professional registration
• Additional office locations

Keeping your profile current helps ensure uninterrupted payments and continued communication from NIHB.

Be Prepared for Claim Verification

Like other health benefit programs, NIHB may review claims before or after payment.

If selected for verification, you may be asked to provide documentation such as:

• Clinical notes
• Treatment plans
• Appointment records
• Proof that services were provided
• Documentation supporting coordination of benefits (when applicable)

Providers should retain records supporting submitted claims for at least five years, as claim verification may occur long after payment has been issued.

Common Reasons Claims Are Delayed or Rejected

Many claim issues can be prevented by reviewing a few key details before submission.

Common problems include:

• Incorrect client identification information
• Missing or invalid Prior Approval number
• Incorrect Provider Number
• Missing claim information
• Claim details that don't match the approved authorization
• Claims submitted after the allowable submission period
• Coordination of benefits information that doesn't match the claim

Checking these details before submitting a claim can significantly reduce resubmissions and payment delays.

Best Practices for Efficient Direct Billing

Experienced NIHB providers often follow a few simple habits:

• Verify client eligibility before each course of treatment.
• Keep track of approved counselling hours.
• Submit claims promptly.
• Review claim statements regularly.
• Maintain complete documentation.
• Use the latest versions of NIHB forms and billing procedures.
• Update provider information whenever your practice changes.

These small administrative habits can save considerable time over the long term.

Always use the official NIHB forms and guides.

NIHB forms and billing guides are updated regularly. Download the latest versions directly from Express Scripts Canada to ensure you have the most current information.

View Official Forms Page

Final Thoughts

Direct billing through the NIHB Mental Health Counselling Program is designed to reduce financial barriers for eligible First Nations and Inuit clients while allowing providers to receive payment directly for approved counselling services.

Although the billing process may seem detailed at first, most providers find it becomes routine once they're familiar with prior approvals, claims submission, and documentation requirements. By following the Claims Submission Kit, keeping accurate records, and staying current with NIHB policies, you can spend less time troubleshooting administrative issues and more time providing high-quality mental health care.