A clinician and a patient reviewing equipment paperwork together at a desk.

For enrolled providers and clinic administrators

Non-Insured Health Benefits (NIHB) on the invoice.

Q: How do clinics bill NIHB for medical supplies and equipment?

A clinic bills Non-Insured Health Benefits as an enrolled provider: it enrols through the medical supplies and equipment provider enrolment package on the Express Scripts Canada NIHB site, names any specialty items on its billing agreement, and for respiratory items keeps a Registered Respiratory Therapist or a Registered Nurse trained in respiratory conditions on staff. For each client it holds a prescription from a prescriber the programme recognizes, written and dated on or before the service date and valid for twelve months, and because prior approval is required for every respiratory equipment and supplies benefit, it sends the respiratory prior approval form to its NIHB regional office with the device make, model and cost, the clinical information the benefit list asks for, and an explanation of benefits from any other coverage the client holds. Only after the approval is granted is the item dispensed, and the claim then goes to Express Scripts Canada carrying the benefit's 8 digit item code and an eligible claim amount worked out from the price file and the item's reimbursement model, with proof that the client received the item kept in the client file.

Q: Does norvelle submit NIHB claims?

No. Claims and prior approval forms go to the programme the way the programme accepts them, and that stays with your team. norvelle holds the approval number, the payer share, the payer invoice and the money.

Q: Is the programme already in the payer directory?

Non-Insured Health Benefits is one of the payers your clinic's directory starts with. What you set is its coverage rule and whether an approval number is required before its share can be billed.

Q: Can we charge the client the difference on a covered item?

No. The programme's balance billing rule says a provider should not bill a client a co-payment or extra charges on a covered item, collect a deposit, or seek compensation from the client, and coverage is not provided to upgrade a benefit. An item the programme does not cover is the client's to pay, and the programme expects them to be told that first.

Q: The client has a private plan as well. Which one is billed first?

The other plan. A client covered by another public or private health plan submits there first, and the programme coordinates afterwards, requiring a copy of that plan's explanation of benefits. On your invoice both payers sit on the same bill, in the order you rank them, and the patient's portion is what the ranked shares leave.

Q: One payment covers forty clients. Does that get split by hand?

No. Apply one remittance across many invoices in a single pass, with its remittance number recorded, and reverse the whole remittance if it does not clear.

Non-Insured Health Benefits is the Indigenous Services Canada programme that covers registered First Nations and recognized Inuit for medically necessary benefits no other plan covers, and this page is about billing it for medical supplies and equipment.

Book a demo See the prior-approval path

Prior approval on every respiratory item The 8 digit item code No co-payment on a covered item

What it covers

Medical supplies and equipment, and the respiratory list inside it.

The programme publishes a benefit list per category. Respiratory is section 8, and it is the one a CPAP or oxygen vendor works from.

The benefit, in the programme's own terms

Medical supplies and equipment cover a client's medical needs in relation to basic activities of daily living, for use at the client's place of primary residence, and the programme pays for the most cost-effective item that meets those needs. Coverage applies where no other private, provincial or territorial plan covers the item.

The respiratory items

Fixed and automatic CPAP, BPAP with and without a backup rate, each as a rental or a purchase, suction machines, compressors and nebulizer kits, the supplies for positive airway pressure, tracheostomy and secretion clearance, plus repairs and delivery. A rental runs up to three months and the rental fee is deducted from the purchase price; a purchased machine carries a replacement guideline of one every five years.

What the price has to include

The NIHB price covers the initial assessment and mask fitting, the full set-up and dispensing with adjustments, all ongoing care including follow-up visits and calls to support use, client education, report generation, and correspondence with the programme and with other health professionals. Sleep disorder diagnostic testing is not covered.

What is excluded

Cleaning and sanitizing machines for positive airway pressure devices and their cleansers, custom-made masks for ventilation, incentive spirometers, high frequency oscillation ventilation, and respiratory benefits for outings while the client is an in-patient. Excluded items are not covered and cannot be appealed.

Registration and prior approval

Before the item leaves the shelf.

Five steps the programme sets out, from enrolment to the claim.

1

Enrol and sign the billing agreement

Enrolment runs through the medical supplies and equipment provider enrolment package on the Express Scripts Canada NIHB site. Enrolled providers are paid directly by the programme, so a client is not out of pocket for a covered benefit.

2

Declare the specialty, and staff it

Specialty items are named on the billing agreement and the credentials behind them are filed with the enrolment. Respiratory items need an enrolled respiratory provider with a Registered Respiratory Therapist, or a Registered Nurse trained in respiratory conditions, on staff at enrolment and kept on staff to keep dispensing.

3

Hold a prescription that meets the rules

From a prescriber the programme recognizes, written and dated on or before the service date, valid for twelve months, client specific, never initiated by the provider for signature, and carrying the prescriber's licence number and a signature that cannot be reproduced.

4

Get prior approval, then dispense

Prior approval is required for every respiratory equipment and supplies benefit. The respiratory prior approval form goes to your regional office with the device make, model and cost, the clinical information the list asks for, and an explanation of benefits from any other coverage. The item is dispensed only after the approval is granted.

5

Claim after it is in the client's hands

Claims carry the 8 digit item code and the eligible claim amount worked out from the price file and the item's reimbursement model. Proof that the client received the item stays in the client file, and client records are kept at least five years.

norvelle

Invoices / INV-11236

Payer allocations

Bill payer

On this invoice

Payer	Rule	Status
Non-Insured Health Benefits (NIHB)	Covered item, approved amount	Approved
Patient portion	Remainder	Nil

Programme share

Item code: 8 digits, recorded
Approval number: Recorded
Programme share: Full approved amount
Patient portion: $0.00

In norvelle

The approval number, the share and what is left.

Non-Insured Health Benefits is one of the payers in the directory your clinic starts with. The coverage rule and the approval-number requirement are yours to set, because they follow the item and the price file, not a single percentage.

The approval number is captured on the programme's share of the invoice, and the payer can be set to require one before that share is billed.
On a covered item there is nothing to chase from the client: the programme's rule is that a provider does not bill a client a co-payment or extra charges, take a deposit, or seek compensation from them. What is left on your invoice is whatever the programme does not cover, and the client is told that before it is supplied.
Where the client has another public or private plan, that plan is billed first and its explanation of benefits goes with the request. Both payers sit on the same invoice, ranked, and the patient's portion is the remainder.
The programme's share can be billed as its own numbered invoice, so federal debt ages apart from the patient's balance.
One remittance covering many clients is applied across many invoices in a single pass, with its remittance number recorded, and reversed whole if it does not clear.
A refused share is appealed, written off, or moved to the patient, and an appeal left 60 days without an answer returns to the patient by itself.

Your team sends the prior approval form and the claim. norvelle records the split, the number and the money. How the split itself works: funding programmes and payer billing.

Questions providers ask.

How do clinics bill NIHB for medical supplies and equipment?

Does norvelle submit NIHB claims?

Is the programme already in the payer directory?

Can we charge the client the difference on a covered item?

The client has a private plan as well. Which one is billed first?

One payment covers forty clients. Does that get split by hand?

Sources

Captured 2026-10-18. Every programme fact on this page was read from Indigenous Services Canada's own published pages on that date. Programme rules change: check the source before you rely on it.

What the programme covers and for whom, the medical supplies and equipment benefit as it relates to activities of daily living at the client's primary residence, and the cost-effectiveness rule: Non-Insured Health Benefits, 1.0 General policies, sections 1.1 and 1.3, sac-isc.gc.ca/eng/1585321312092 (effective 2026-07-29).
Enrolment through the medical supplies and equipment provider enrolment package, enrolled providers paid directly, specialty items declared on the billing agreement with credentials filed, and the provider responsibilities including proof of dispensing and records kept at least five years: the same page, sections 1.1, 1.2, 1.4 and 1.5.2.
Prescription requirements, including the twelve month validity, the ban on a provider initiating a prescription for signature, and the signature rules: the same page, section 1.7.
The prior approval process, its attachments, and the urgent categories including oxygen or a ventilator required to sustain life and positive airway pressure devices for severe obstructive sleep apnea: the same page, section 1.9.
Rentals limited to three months with the rental amount deducted from a later purchase, repairs and warranties: the same page, sections 1.13 to 1.15.
The eligible claim amount, the price files and the reimbursement models: the same page, section 1.16.
Coordination of benefits, with the other public or private plan billed first and its explanation of benefits required: the same page, section 1.20.
Balance billing: no co-payment or extra charges on a covered item, no deposit, no compensation sought from the client, and no coverage to upgrade a benefit: the same page, section 1.21. An approved item not picked up within thirty days returned to inventory: section 1.22.
Prior approval required for all respiratory equipment and supplies benefits, the enrolled respiratory provider with a Registered Respiratory Therapist or a Registered Nurse trained in respiratory conditions on staff, the recognized prescribers, the three month rental with the fee deducted from the purchase price, the five year replacement guideline on a purchased machine, the services that must be inside the price, the exclusions, and the 8 digit item code: 8.0 Respiratory equipment and supplies benefits list, sac-isc.gc.ca/eng/1585323161648 (effective 2026-07-29).

See a federally funded invoice built.

Watch the approval number, the programme share and the patient remainder land on one invoice.

Book a demo See funding and payer billing