AADL – Administration information for authorizers and vendors

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General administration topics

Eligibility for AADL benefits

Alberta Aids to Daily Living (AADL) does not cover clients with First Nations Treaty status, those receiving Workers’ Compensation for the same problem or those who are funded under Veterans’ Affairs for a pre-existing condition as a result of active duty.

Read more about eligibility requirements for clients

No assessments over the phone

Specialty suppliers (vendors) must use the Alberta Blue Cross online health portal after assessing a client and authorizers must assess their clients in person.

Expiry date for a claim

Claims must be submitted prior to six months from the service date and any rejections resolved prior to 12 months from the service date.

No promotion of additional AADL benefits

Vendors may not “promote” AADL benefits. If vendors think a client requires additional benefits or changes to their equipment and/or supplies, they should refer the client back to an authorizer.

Advise the client of their responsibilities

You are responsible to make clients aware of their responsibilities, such as filling out all applicable forms, for example, satisfaction form or cost-share exemption form.

AADL complaint registry

The AADL complaint registry is available to the public, clients, authorizers, assessors and vendors.

The complaint registry is AADL’s internal complaint mechanism. It incorporates a process to resolve specific types of complaints, and documents who complains, the nature of the complaint, who was designated to investigate the complaint, findings of the inquiry, and action taken.

Complaints must be submitted to AADL on the designated complaint form, also available directly from AADL.

• Complete the AADL Complaint form

Generally complaints are investigated and findings communicated to the complainant within 45 business days.

Assessment, trial and service date

The assessment date occurs when client’s eligibility for AADL benefits and need(s) are determined. The service date occurs when client is provided the benefit. The trial date occurs when the equipment is sent out for trial by the client. The vendor can only invoice AADL after the trial is completed and the equipment is chosen.

Benchmark pricing

Some benefits are described generically, allowing the client and authorizer to choose the benefit or equipment model that best meets the client’s need. AADL sets a price for the benefit group. If the vendor's shelf cost is more, the client pays the extra cost. If it is less, the vendor must bill AADL for the benefit at the lower price.

For example, AADL benchmark price for a walker is $359. The vendor shelf price is $459, although the vendor does have another walker at the benchmark price. If the client chooses the $459 walker, they would pay the extra $100. If the client is cost-sharing, they would also pay 25% of $359 for a total of $189.75.

The vendor may choose the selling price of their products, but must offer a choice at the benchmark price.

Product upcharge

There are 2 ways to price stock:

• Contracted prices / fixed prices – the vendor must sell at this price for the duration of the contract.
• Benchmarked prices – the vendor may choose the selling price BUT must offer a choice at the benchmark price.

If the client chooses a product that costs more than the benchmark, the client is then responsible for paying the upcharge.

Cost sharing

Cost-share is based on the client’s family income, up to a maximum of $500 per family per benefit year (July 1 – June 30). If the client’s family income is below a set amount determined each benefit year, they are exempt from cost-share. A client’s cost-share status is found on the Alberta Blue Cross online health portal. Vendors must charge the client cost-share unless the client is cost-share exempt.

Vendors may not ask for the $500 up front from the client. A vendor is only allowed to collect what is being billed and invoiced. Vendors must use the Alberta Blue Cross online health portal to check cost-share status, including cost-share predetermination on the claims page, to determine how much cost-share the client is owing, if any. Vendors are responsible for reimbursing clients for any cost-share payments collected over the $500 maximum.

To be eligible for cost-share exemption status, the low-income, Income Support Program (ISP) or Assured Income for the Severely Handicapped (AISH) client must have lived within Canada for the past 12 months and within Alberta for at least the past three months. The cost-share exemption benefit year is from July 1 to June 30 and is based on the invoice date (not the date of application).

Quality and Frequency Review (QFR)

Vendors cannot initiate a QFR. Only an authorizer or a specialty supplier can initiate a QFR request.

Mistakes

Vendor errors are the financial responsibility of the vendor. Vendors cannot bill for their mistakes as noted in the AADL General Policies and Procedures.

Keeping inventory

Inventory requirements are specified on contracts and purchase agreements. Please review your contract.

Physical records retention and destruction

AADL policy and procedures require vendors to keep records for 10 years. After this period, records can be destroyed. When records are to be disposed of, the vendor must protect confidentiality. Here are some best practices for destruction of records –

• Records must be shredded to ensure they cannot be reconstructed, and to prevent unauthorized use or access to the obsolete record.
• Shredders should cut paper diagonally with strips at least as small as 1.59 cm (5/8”).
• Materials that resist shredding for example water resistant paper, mylar, or reinforced paper should be handled with a different destruction method.
• Shredded materials should be disposed of in an environmentally safe manner.
• Duplicate copies of records (transitory records) containing health information should be kept to a minimum.
• Once the record’s purpose is fulfilled, only the original copy should be retained. Duplicate records should be shredded.
• If records are waiting to be destroyed, they must be locked in a secure place to prevent unauthorized access.
• A log of what records are destroyed, when, how, by who, and who authorized the destruction should be kept for audit purposes.
• A manager should witness the destruction of records.
• If shredding is done by a third party service, a certificate of destruction should be obtained once records are destroyed.

Electronic records containing health information, like diskettes, CDs or hard drives must also be destroyed according to best practice. For example, shred or break CDs or diskettes, securely wipe or demagnetize them.

Satellite clinics

A satellite clinic is a clinic that is not staffed five days a week, meaning a client cannot access services full-time. For example, many hearing vendors will do a once a week, or once a month clinic in remote locations. Another example of a true satellite is a hearing aid vendor who attends a clinic in a nursing home once a month.

The satellite clinic does not have a permanent fixed location. In other words, the equipment is moved to the location each time staff is at the clinic.

If the actual specialty assessor attends the office on an infrequent basis but there are other employees who staff the office on a full-time basis, it is not considered a satellite clinic. A satellite clinic would also not be one that would receive mail or have an actual business address or storefront.

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