Pharmacy Providers

Pharmacy Forms
Claim Reversal Request
Acquisition Cost Request Pharmacy providers only should use this form to request "cost-to-operator " adjustments in the event that reimbursement on a given claim was less than your actual acquisition cost for the item claimed.
Adjustment Pharmacy providers only should use this form to correct any incorrect or unknown information on the initially submitted claim (eg. to correct an incorrect DIN, correct a package size, quantity, or days supply,etc.).
Pharmacy Claim Submission Form Pharmacy providers may use this form to submit a manual claim in the event that the claim cannot be processed electronically. This form can be used for regular or compound claims.
Drug Authorization Forms A Drug Special Authorization form is required when a pharmacy receives a denial for an electronic drug claim that requires prior authorization.
Fill Limits Exception Request Form Request for coverage of additional dispensing fees associated with exceptions to the maintenance medication dispensing frequency policy (3 months supply) and/or use of compliance packaging.
Provider Banking Information Update form
Claims Payment Schedules
For your convenience, we have made our Claim Payment Schedules for each line of business available online. This will help you determine what claim details are included in each payment. To view these schedules, choose from the following:
Current Year
Prior Year
Update Newsletters

Green Shield Canada's Update newsletters give you the latest information on trends in the industry and Green Shield Canada news. Please choose from the list below (available in PDF format):

"It's your drug plan" consumer brochure.

Pharmacy Manuals

Select a document below to view (in PDF) or print a copy:

Enhanced Generic Substitution
Frequently Used PINs for Billing Purposes
Intervention Codes
Maintenance Medication List
Maintenance Medication Policy Flowchart
Maintenance Medication Policy (Slides Only)
Maintenance Medication Policy (Webinar Recording)
Pharmacy Claims Manual
Topical Extemporaneous Compounds Policy

For more detailed inquiries about drug eligibility, criteria, other Green Shield Canada policies, etc., please contact our Customer Service Centre at 1-888-711-1119.

Pharmacy Forms
Claim Reversal Request
Acquisition Cost Request Form Pharmacy providers only should use this form to request "cost-to-operator " adjustments in the event that reimbursement on a given claim was less than your actual acquisition cost for the item claimed.
Pharmacy Adjustment Form Pharmacy providers only should use this form to correct any incorrect or unknown information on the initially submitted claim (eg. to correct an incorrect DIN, correct a package size, quantity, or days supply,etc.).
Pharmacy Claim Submission Form Pharmacy providers may use this form to submit a manual claim in the event that the claim cannot be processed electronically. This form can be used for regular or compound claims.
Provider Banking Information Update form
Request For Brand Name Drug Coverage This information is required to assess your request for coverage of a non-generic drug.
Claims Payment Schedules
For your convenience, we have made our Claim Payment Schedules for each line of business available online. This will help you determine what claim details are included in each payment. To view these schedules, choose from the following:
Current Year Québec
Current Year Outside Québec
Prior Year Québec
Prior Year Outside Québec
Update Newsletters

SSQ’s Update newsletters give you the latest information on trends in the industry and SSQ Financial group news. Please choose from the list below (available in PDF format):

Pharmacy Manuals

Select a document below to view (in PDF) or print a copy:

Pharmacy Claims Manual
Frequently Used PINs for Billing Purposes

For more detailed inquiries about drug eligibility, criteria, other SSQ policies, etc., please contact our Customer Service Centre at 1(800) 463-6262



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