Express Scripts Canada
Express Scripts Canada
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NIHB Medical Supplies and Equipment Provider Documentation

Registration

Instructions

To register in the Medical Supplies and Equipment (MS&E) NIHB Program:
1. Download the Medical Supplies and Equipment Provider Agreement:
pdf icon Medical Supplies and Equipment Provider Agreement

Sample Copy of a completed Medical Supplies and Equipment Provider Agreement:
pdf icon Medical Supplies and Equipment Provider Agreement (Completed Sample)
2. Complete the Medical Supplies and Equipment Provider Agreement fully for all required sections.
 Did you know…
 Electronic Funds Transfer (EFT) is free and secure?
 Sign up by completing the Payment Information section of the Medical Supplies and Equipment Provider Agreement and eliminate mail delivery delays of lost, misplaced, or stolen cheques! Receive your claim payments directly into your designated bank account on the day the payment is issued and still continue to receive mailed statements for reconciliation!
3. Sign the Medical Supplies and Equipment Provider Agreement (where indicated).
4. Fax all pages (including a photo copy of a VOID cheque or official bank letter for EFT payments) of the Medical Supplies and Equipment Provider Agreement to Express Scripts Canada at fax number 1-855-622-0669.


MS&E Forms

Claim

pdf icon NIHB Medical Supplies and Equipment Claim Form


Prior Approval and Confirmation Letters

pdf icon NIHB Hearing Aid and Hearing Aid Repair Confirmation Form

pdf icon NIHB Hearing Aid and Hearing Aid Repair Prior Approval Form

pdf icon NIHB General Medical Supplies and Equipment Prior Approval Form

pdf icon NIHB Orthotics - Custom Footwear - Prosthetics - Pressure Garments Prior Approval Form

pdf icon NIHB Oxygen and Respiratory Medical Supplies and Equipment Prior Approval Form


Claims Submission Kit

pdf icon NIHB Medical Supplies and Equipment Claims Submission Kit

pdf icon NIHB Medical Supplies and Equipment Claims Submission Kit Attachments


Provider Information Changes

pdf icon Modification to Pharmacy and Medical Supplies and Equipment Provider Information Form


Contacts

Express Scripts Canada Provider Claims Processing Call Centre
Extended Hours of Operation: Monday to Friday
6:30 a.m. - 8:30 p.m. ET, excluding Statutory Holidays
 
Telephone Inquiries: 1-888-511-4666
 
Mail:   For MS&E claims, mail to:
    Express Scripts Canada
NIHB MS&E Claims
P.O. Box 1365, Station K
Toronto, ON M4P 3J4
 
    For all other correspondence, mail to:
    Express Scripts Canada
5770 Hurontario St., 10th Floor
Mississauga, ON L5R 3G5
 
Health Canada
Click Health Canada Contacts to view all the NIHB Program contact numbers.

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www.express-scripts.ca
www.healthcanada.gc.ca/nihb