Express Scripts Canada
Express Scripts Canada
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NIHB Dental Provider Documentation



To enroll in the Dental NIHB Program:
1. Download the Dental Provider Enrollment Form:
pdf icon Dental Provider Enrolment Form

Sample Copy of a completed Dental Provider Enrollment Form:
pdf icon Dental Provider Enrolment Form (Completed Sample)
2. Complete the Dental Provider Enrollment Form fully for all required sections.
 Did you know…
 Electronic Funds Transfer (EFT) is free and secure!
 Sign up by completing the Payment Information section of the Dental Provider Enrollment Form and eliminate mail delivery delays of lost, misplaced, or stolen cheques! Receive your claim payments directly into your designated bank account on the day the payment is issued and still continue to receive mailed statements for reconciliation!
 Electronic Data Interchange (EDI) is a point of service, claim submission method to submit Dental claims electronically in real time!
 Purchasing a software compliant with CDAnet Electronic Claim Standard, Denturists Association of Canada (DACnet) or Réseau ACDQ (Association des chirurgiens dentistes du Québec) will expedite your claim submissions. Why not consider it today! For more information, contact your association to be advised of the list of certified software vendors.
3. Sign the Dental Provider Enrollment Form (where indicated).
4. Fax all pages (including a photo copy of a VOID cheque or official bank letter for EFT payments) of the Dental Provider Enrollment Form to Express Scripts Canada at fax number 1-855-622-0669.

Dental Forms


pdf icon NIHB Dental Claim Form


pdf icon NIHB Completion of Active Orthodontic Treatment Form

pdf icon NIHB Orthodontic Summary Sheet

pdf icon NIHB Application for Orthodontic Examination and Diagnostic Records

Claims Submission Kit

pdf icon NIHB Dental Claims Submission Kit

Dental Hygienist Provider Enrolment Form

pdf icon Dental Hygienist Provider Enrolment Form

Provider Information Changes

pdf icon Modification to Dental Provider Information Form


Express Scripts Canada Provider Claims Processing Call Centre
Extended Hours of Operation: Monday to Friday
6:30 a.m. - 8:30 p.m. ET, excluding Statutory Holidays
Telephone Inquiries: 1-888-511-4666
Mail:   For Dental claims, mail to:
    Express Scripts Canada
NIHB Dental Claims
3080 Yonge St., Suite 3002
Toronto, ON M4N 3N1
    For all other correspondence, mail to:
    Express Scripts Canada
5770 Hurontario St., 10th Floor
Mississauga, ON L5R 3G5
Health Canada
Click Health Canada Contacts to view all the NIHB Program contact numbers.

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