# Insurance Billing Quick Reference

Provider contacts, BIN numbers, carrier IDs, and setup instructions for Canadian pharmacy insurance billing.

Covers 36 insurance carriers. Canonical HTML version: https://pharmflow.io/guides/insurance-billing

## Carriers

| Carrier | BIN | Network | Carrier code | Phone |
| --- | --- | --- | --- | --- |
| Canada Life (Great-West Life) | 600526 | NDC | 11 | 1-800-957-9777 |
| Sun Life Financial | 600526 | NDC | 16 / EP | 1-800-361-6212 |
| Manulife (ESI) | 610059 | NDC | 610059 | 1-800-268-6195 |
| Pacific Blue Cross | 610519 | PBC | PB | 1-888-275-4672 |
| Medavie Blue Cross | 610047 | ABBC | MC | 1-888-588-1212 |
| Green Shield Canada (GSC) | 610065 | NDC | G1 | 1-888-711-1119 |
| Desjardins Insurance | 600526 | NDC | 51 | 1-800-463-7890 |
| Industrial Alliance (iA Financial) | 600526 | NDC | 000060 | 1-800-463-6236 |
| NIHB (Non-Insured Health Benefits) | 610068 | NDC | ESI | 1-800-580-0950 |
| ClaimSecure | 610019 | NDC | CS | 1-888-513-4464 |
| Equitable Life | 600526 | NDC | 29 | 1-800-265-8878 |
| Beneva (La Capitale) | 600526 | NDC | 62 | 1-888-423-6382 |
| Ontario Drug Benefit (ODB) | N/A | Ontario HNS | ODB | 1-866-811-9893 |
| DVA / RCMP / DND (Veterans & Federal) | 610047 | ABBC | 610047 | 1-888-588-1212 |
| IFHP / Refugee Claims (IFH) | 610047 | ABBC | C1 | 1-888-614-1880 |
| First Nations Health Authority (FNHA) | 610519 | PBC | E1 | 1-855-550-5454 |
| Alberta Blue Cross | 111111 | ABBC | 11 | 1-800-661-6995 |
| Manitoba Blue Cross | 610530 | MAN | 02 | 1-800-873-2583 |
| Saskatchewan Blue Cross | 611797 | SBC | 46 | 1-800-667-6853 |
| Manulife (NDC) | 610059 | NDC | 610059 | 1-800-268-6195 |
| Bigstone Band (NIHB) | 610137 | NIHB | BS | 1-800-814-3684 |
| SSQ Insurance | 610074 | NDC | 610074 | 1-800-848-0158 |
| MDM (Maximum Benefit) | 601052 | NDC | 601052 | 1-800-267-6522 |
| Liberty Health | 610055 | NDC | 610055 | 1-800-268-5840 |
| Esorse (CATPA) | 610650 | NDC | 610650 | 1-800-268-9191 |
| Canadian Benefit Providers (CBP) | 610202 | NDC | 610202 | 1-800-665-5596 |
| NexgenRx | 610634 | NDC | 610634 | 1-844-639-4369 |
| DeltaWare | 610172 | NDC | 610172 | 1-800-565-5200 |
| Olympia Trust | 604647 | NDC | 604647 | 1-800-makeaclaim |
| BC Cancer Agency | N/A | CA billing | CA | 1-800-663-3333 |
| DVA (Veterans Affairs) | 610047 | ABBC | V1 | — |
| RCMP | 610047 | ABBC | R1 | — |
| DND (Department of National Defence) | 610047 | ABBC | D1 | — |
| Worksafe BC (WCB) | 600526 | NDC | 37 | — |
| Express Scripts Canada (ESI) | 610068 | NDC | ESI | — |
| TELUS Health / Assure | 600526 | NDC | TELUS | — |

## Networks

- **TELUS Health** (TELUS): Most private employer group plans
- **ESI Canada** (ESI): Express Scripts / Sun Life / Manulife ESI
- **ESI / TELUS (Dual)** (ESI / TELUS): Carriers that route through both networks
- **Blue Cross (ABBC)** (ABBC): Atlantic / Alberta Blue Cross & federal plans
- **Pacific Blue Cross (PBC)** (PBC): BC-based carriers
- **Manitoba Blue Cross** (MAN): Manitoba network
- **Saskatchewan Blue Cross** (SBC): Saskatchewan network
- **NDC Health** (NDC): National Drug Code network
- **NIHB** (NIHB): Non-Insured Health Benefits
- **GreenShield Direct** (GSC Direct): GreenShield Canada direct billing
- **ClaimSecure Direct** (ClaimSecure Direct): ClaimSecure direct billing
- **Ontario Provincial** (Ontario HNS): Ontario Health Network System
- **Cancer Agency** (CA billing): BC Cancer Agency direct billing

## Dependent codes

Standard 2-digit codes appended to member IDs to identify the relationship to the cardholder.

| Code | Relationship |
| --- | --- |
| 00 | Cardholder (primary) |
| 01 | Spouse / Partner |
| 02 | Dependent child #1 |
| 03 | Dependent child #2 |
| 04 | Dependent child #3 |
| 05 | Dependent child #4 |
| 06 | Dependent child #5 |
| 07 | Dependent child #6 |
| 08 | Dependent child #7 |
| 09 | Dependent child #8 |

## Billing notes

- **Standard markup:** most private insurers accept the pharmacy's usual and customary (U&C) fee. Provincial plans (ODB, PharmaCare) have regulated dispensing fees and markups.
- **Lower-cost alternative (LCA):** many plans reimburse only the lowest-cost generic equivalent. If the patient requests brand name, the difference is billed to the patient as a copay.
- **Coordination of benefits (COB):** when a patient has multiple plans, always bill the first payer (government/public plan) first, then submit the balance to the second payer.
- **Compounds:** most insurers require compound descriptor codes: 1 = cream/ointment, 2 = capsule, 3 = solution, 4 = suppository, 5 = other.

## Frequently asked questions

### Which BIN do I use for a TELUS Health claim?

TELUS Health network carriers in this guide bill through BIN 600526 — for example Canada Life (carrier 11), Sun Life (carrier 16) and Desjardins (carrier 51). Express Scripts Canada (ESI) plans use a different BIN, 610068. Always confirm the BIN printed on the patient's card before submitting.

### How do I bill a patient who has two insurance plans?

Bill the first payer first, then submit the balance to the second payer. Government and public plans (NIHB, DVA, RCMP, DND, ODB, PharmaCare) are always the first payer. Private employer plans are billed second.

### What dependent code do I enter for a spouse or child?

Append a 2-digit code to the member ID: 00 for the cardholder, 01 for a spouse or partner, and 02 through 09 for dependent children. GreenShield cards instead use a dash suffix on the ID itself (-00 primary, -01 spouse, -02 and up for dependents).

### How do I bill a compound prescription?

Most insurers require a compound descriptor code with the claim: 1 for cream or ointment, 2 for capsule, 3 for solution, 4 for suppository, and 5 for other. Check the specific insurer's compound billing rules before dispensing.

### What does lower-cost alternative (LCA) mean for reimbursement?

Many plans reimburse only the lowest-cost generic equivalent. If the patient requests the brand-name product, the price difference is billed to the patient as a copay. Check the plan's LCA rules before dispensing.

### Is NIHB always the first payer?

Yes. NIHB (Non-Insured Health Benefits, billed through ESI with BIN 610068) is a government plan and must be billed before any private insurance. The same first-payer rule applies to DVA, RCMP, DND and provincial plans.

### Sun Life lists two carriers — which one do I use?

Sun Life bills through TELUS as carrier 16 and through ESI as carrier EP (BIN 610068). Manulife is similar: ESI plans use BIN 610068 with carrier 02, while older non-ESI plans route through NDC with BIN 610059. Match the network printed on the patient's card.