Common Questions From NIHB Mental Health Providers

Whether you're thinking about becoming an NIHB provider or have recently enrolled, it's normal to have questions about billing, prior approvals, documentation, and program requirements.

This guide answers some of the most common questions therapists and counsellors ask when providing services through the Non-Insured Health Benefits (NIHB) Mental Health Counselling Program.

Do I Need to Be Approved Before Seeing NIHB Clients?

Yes.

Before you can bill NIHB for counselling services, you must be enrolled as an NIHB Mental Health Counselling Provider through Express Scripts Canada.

This involves completing the Provider Enrolment Package, meeting the program's eligibility requirements, and receiving your unique NIHB Provider Number.

Which Mental Health Professionals Can Become NIHB Providers?

Eligibility depends on your province or territory, but commonly eligible professions include:

• Registered Social Workers
• Registered Psychologists
• Psychological Associates
• Registered Psychotherapists or Counselling Therapists
• Registered Psychiatric Nurses

You must also be authorized for independent practice and remain in good standing with your regulatory college.

How Do I Know If a Client Is Eligible?

Before providing services, verify that your client is eligible for NIHB benefits.

You'll generally confirm:

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

Verifying eligibility before treatment helps reduce claim problems later.

Do All Counselling Sessions Require Prior Approval?

No.

The first 2 hours of counselling can generally be provided without prior approval.

If additional counselling is clinically appropriate, you'll submit a Prior Approval request explaining why further treatment is recommended.

Once approved, you'll receive a Prior Approval number to use when submitting claims.

How Do I Submit NIHB Claims?

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

The online portal allows you to:

• Submit claims
• View claim status
• Access claim statements
• Submit Prior Approval requests
• Update provider information

Electronic submission is the fastest and simplest way to bill NIHB.

How Often Are Providers Paid?

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

You can review payment information and claim statements through your Provider Web Account.

Keeping your banking information current helps prevent payment delays.

What Documentation Should I Keep?

Providers should maintain complete clinical records that support every claim submitted.

Documentation typically includes:

• Progress notes
• Treatment plans
• Appointment records
• Session dates and duration
• Clinical interventions
• Documentation supporting coordination of benefits when applicable

Good documentation protects both you and your clients if claims are reviewed.

How Long Should I Keep Client Records?

NIHB may verify claims for up to five years after payment.

Providers should retain documentation supporting submitted claims for at least this period, while also complying with any longer record retention requirements established by their professional regulatory college.

What Happens If My Claim Is Rejected?

Claim rejections are usually administrative rather than clinical.

Common reasons include:

• Incorrect client information
• Missing Prior Approval number
• Incorrect Provider Number
• Claim submitted after the allowable timeframe
• Missing claim information
• Claim details that don't match the approved authorization

Reviewing your Claim Statement and Response Codes will usually identify the issue so it can be corrected.

Can I Change My Practice Information Later?

Yes.

If your practice changes, notify NIHB as soon as possible.

Examples include:

• Practice address
• Business name
• Banking information
• Contact information
• Professional registration
• Additional office locations

Keeping your provider profile current helps ensure uninterrupted billing and payments.

Can I Offer Virtual Counselling?

Yes.

NIHB recognizes secure video and telephone counselling when delivered in accordance with current program policies and your professional standards.

Many providers now offer a combination of virtual and in-person services.

What Happens If My Claims Are Selected for Verification?

From time to time, NIHB reviews claims to ensure they comply with program requirements.

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

• Progress notes
• Treatment plans
• Appointment records
• Proof services were provided

Maintaining organized documentation makes the verification process much easier.

Where Can I Find the Latest NIHB Forms?

Always download forms directly from the official NIHB provider resources.

Using the latest versions of the:

• Provider Enrolment Package
• Claims Submission Kit
• Prior Approval forms
• Provider Bulletins

This helps ensure you're following the most current program requirements.

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

Where Can I Get Help?

If you have questions about enrolment, billing, prior approvals, or claim processing, several resources are available.

Helpful places to start include:

• Express Scripts Canada Provider Support
• NIHB Provider Web Account
• NIHB Provider Bulletins
• Claims Submission Kit
• Your regional NIHB office

Many billing questions can also be answered by reviewing your Claim Statement or the current Claims Submission Kit before contacting support.

Final Thoughts

Most therapists find that providing counselling through NIHB becomes straightforward once they're familiar with the enrolment process, prior approvals, and billing procedures.

Keeping accurate documentation, staying current with program updates, and using the latest NIHB forms will help ensure claims are processed smoothly while allowing you to focus on providing high-quality care to First Nations and Inuit clients.