Shadow billing
- Process where non-fee-for-service providers (NPs and physicians) submit claims.
- The information is used to maintain a consistent patient history to: 1) ensure accountability and 2) assists with future health care resource planning.
- Allows the capture of all immunizations in the Medicare system.
- Does not involve pharmacies or payments.
For more info: GNB – Health Professionals: see Medicare section
Insurance billing
Involves a third-party payer:
- pharmacists billing insurance companies
- dentists billing insurance companies
- NPs or MDs billing insurance companies
- RNs billing insurance companies (ie footcare)
The provider of the service receives a payment.
Pharmacy billing/Prescription Monitoring Program and Drug Information System
When a pharmacy receives a script, they generally bill the insurance company, the province, or the patient. The ordering provider is entered in the pharmacy system (in NB, this is the Drug Information System known as DIS). This flows to the patient’s provincial Electronic Health Record (EHR). Authorized healthcare professionals can view a patient’s medication history in real-time in the EHR, including who the prescriber was and which pharmacy was used to purchase the medication. All community pharmacies are connected to this information system and submit prescription information. This is the way our provincial Prescription Monitoring Program (PMP) works.
NPs need to request access to the EHR to be granted a user ID and password. This will allow them to see their patients’ EHRs.
For more info: GNB – Health Professionals: see Pharmaceutical Services section