FAQs

The following questions will be of interest to Book of Business Dental and Pharmacy providers:

How can dental providers register to submit claims to Express Scripts Canada?

No enrolment form is required. Dentists (excluding denturists and hygienists who want to submit Electronic Data Interchange [EDI] claims) should contact the Provider Call Centre toll-free at 1 (800) 563-3274. One of our representatives will be pleased to assist you.

How do registered dental providers make changes to their information?

Dental providers must complete a Modification to Dental Provider Information Form and send it, via facsimile, to the Provider Relations Department at (905) 712-0669.

How can pharmacists register to submit claims to Express Scripts Canada?

Pharmacists should contact the Provider Call Centre toll-free at 1 (800) 563-3274. One of our representatives will be pleased to assist you.

How do pharmacists make changes to their information?

Pharmacists must complete a Modification to Pharmacy Provider Information Form and send it, via facsimile, to the Provider Relations Department at (905) 712-0669.

What is Electronic Data Interchange (EDI)?

Electronic Data Interchange (EDI) is a point-of-service claim submission service which expedites claims submissions electronically and directly from the Provider’s office software in real time, acknowledging the result of the claim sent immediately. Providers are asked to contact the respective association for a list of certified software vendors. Upon set up of the software, please contact the association and Express Scripts Canada to advise that you are EDI-ready.

Instead of mailing a cheque to me, can a provider’s claims be directly deposited to their bank account through electronic funds transfer (EFT)?

Electronic Funds Transfer (EFT) is a FREE and secure electronic payment service that directly deposits claim payments into a provider’s designated bank account on the day the payment is issued. Please complete a Healthcare Provider Electronic Funds Transfer (EFT) Request Form attaching a VOID cheque or official bank letter and return to Express Scripts Canada as directed on the form. [The form may be downloaded from the Express Scripts Canada Web site at www.provider.express-scripts.ca

How do dental providers set up EFT for their accounts?

Dental providers must complete a Modification to Dental Provider Information Form, along with a void cheque or official bank letter, and send it, via facsimile, to the Provider Relations Department, at (905) 712-0669.

How do pharmacists set up EFT for their accounts?

Pharmacists must complete a Modification to Pharmacy Provider Information Form along with a void cheque or official bank letter, and send it, via facsimile, to the Provider Relations Department at (905) 712-0669.

Can providers sign up for both EDI and EFT for the submission and payment of claims?

Yes. In doing so, claims are submitted and received at Express Scripts Canada in real-time. When the claim is adjudicated and paid, the funds are deposited into your designated bank account the same day. Your statements will continue to be mailed.

Are statements mailed with payment cheques?

Yes. Statements are mailed with payment cheques. The frequency of the statement received is set per benefit type.

Will pharmacy providers who register for Express Scripts Canada automatically be registered for the Non-Insured Health Benefits (NIHB) program as well?

Yes. Express Scripts Canada’s Provider Relations team will register pharmacy providers for both Express Scripts Canada and the NIHB program.  The Provider Number received will be the same for both programs.

If a pharmacy provider has already completed registration for NIHB agreement, do they have to complete all the pages in the Express Scripts Canada agreement as well?

Yes. To be registered for Express Scripts Canada, please complete all fields and submit all pages to Provider Relations. The NIHB agreement only registers a provider for the NIHB program.

Do providers need to send back all the pages of the agreement?

Yes. All pages of the agreement must be submitted, via facsimile, to the Provider Relations Department. The fax number is (905) 712-0669.