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Partial Denture Trial Project Announcement

​The First Nations Health Benefits (FNHB) Program is participating in the Non-Insured Health Benefits (NIHB) Program's nationwide eight-year partial denture trial project. The project will assess the merits, feasibility and appropriateness of a streamlined predetermination (PD) submission process for partial dentures under the FNHB Program's dental benefit.

Start date: ​February 19, 2018

Please send your trial project predetermination requests by fax to 

​604-666-5815.

 

General Trial Conditions: ​

• Please read the FNHB Partial Denture Trial Project Form as it contains all the requirements under the project, including the criteria for coverage and consequence of non-compliance.  

• The trial project is open to all dentists and denturists enrolled with the FNHB Program.  

• Participation in the trial project is voluntary. Providers can decide to participate by submitting qualifying partial denture cases to the FNHB dental fax line. Providers who choose not to participate are to submit their partial denture cases through the regular predetermination (PD) process.  

• Under the trial project, FNHB will accept faxed PD submissions sent to the dental fax number for new or replacement partial dentures meeting the frequency requirements as outlined in the NIHB Removable Prosthodontic Policy.  

• Each PD submitted under the trial project must be accompanied by a completed and signed FNHB Partial Denture Trial Project Form. The form is available to download and print at: ​

www.fnha.c​a/bene​fits/dental​​

•​ ​All other dental services requiring PD must follow the regular PD process. This includes partial denture cases that do not meet frequency requirements.

Please Note: The Program reserves the right to make changes to the trial project and to discontinue it at any time. Providers will be informed in a timely manner of such changes.

The following table summarizes and compares the trial project submission process to the regular PD process for partial dentures under the FNHB Program:

 ​ACCEPTED CASES UNDER THE PARTIAL DENTURE TRIAL PROJECTALL OTHER CASES MUST FOLLOW THE REGULAR PD SUBMISSION PROCESS
Type of cases submittedEligible partial dentures meeting frequency requirementsAll other eligible services requiring PD, including partial dentures not meeting frequency requirements
PD request must be submitted by:FAX: 604-666-5815

MAIL: FNHB

540 – 757 West Hastings Street

Vancouver, BC

V6C 1A1

FNHB Partial Denture Trial Project Form

Required for each case;

FAX: 604-666-5815

Not required
Supporting Documentation

Do not send documentation;

Keep it on file for the duration of the project

MAIL documentation to the FNHB
Periodontal criteriaThe periodontal criteria below will not be applied for the duration of the projectThe periodontal criteria below will not be applied for the duration of the project

Periodontal criteria:

"All abutment teeth must have: adequate periodontal support, based on alveolar bone levels (crown to root ratio of at least 1:1) visible on submitted radiographs; and absence of active periodontal disease".

 

"If there is evidence of periodontal disease, the FNHB Program will not consider coverage for a cast partial denture. However, in such situations, the Program may consider coverage for an acrylic partial denture."​

 (References from Dental Benefits Guide, section 8.6.2.)

Compliance Monitoring

During the trial project, the FNHB Program will conduct compliance monitoring with the criteria described in section A of the FNHB Partial Denture Trial Project Form, which includes the following measures: 

  • Providers may be randomly selected and requested to submit to the Program supporting documentation pertaining to selected trial project cases. 

  • A Partial Denture Trial Project Committee will be established to assess selected paid partial dentures against the trial criteria. 
     
  • Failure to submit the required documentation when requested or non-compliance with the FNHB Partial Denture Trial Project criteria will result in recovery of 100% of the provider's professional fee paid by the FNHB Program per partial denture. Where funds have been recovered, the provider cannot bill the client for these recovered amounts. Note that laboratory fees will not be subject to recovery. 
     
  • Repeated non-compliance with the trial project criteria may result in the provider being removed from the trial project, and therefore the provider will need to submit all cases through the regular PD submission process.
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