General information for authorizers and vendors

1. 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 preexisting condition.

2. No assessments over the phone

Specialty suppliers (vendors) must use e-business after assessing a client and authorizers must assess their clients in person.

3. 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. Unresolved claims and unpaid claims which have expired are AADL’s biggest problem. Please note that vendors can print an e-business report that can indicate which claims have been paid and what is outstanding. For claims questions that cannot be resolved through e-business, please call one of AADL's claims clerks using our telephone listing. View it here.

4. No promoting 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.

5. Advise the client of their responsibilities

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

6. 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.

The Program Analysis and Accountability Unit (PAAU) is responsible for the Complaint Registry within the Health Related Supports Branch, because PAAU is not involved in the daily operations of AADL, AISH or RAMP.

This allows them to meet fairness guidelines, which includes: impartiality, independence, removal of potential bias or conflicts of interest. The Complaint Registry is to be used to improve the AADL Program by providing quality service and fostering improved relationships with all stakeholders.

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

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

7. Differences between assessment date, trial date 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.

Example: The client is assessed by the authorizer for a walker on December 1, 2017. The authorizer should put on the 1250 form an assessment date of December 1, 2017 but this is not always the case. The actual model/style of equipment is yet to be determined. The client will choose a vendor and then the authorizer normally contacts the vendor to arrange for a trial of equipment.

The vendor will deliver/send out the equipment December 2, 2017, they will usually have some type of dated document, e.g., courier slip, delivery slip and they may refer to the date on this document as the trial date – December 2, 2017, this date is not normally used by AADL.

The client and the authorizer will then determine if the equipment is appropriate and should contact the vendor to let them know. Sometimes authorizers do not contact the vendor and simply then send out the 1250 form. Some authorizers will now complete the 1250 form and use the date they confirm that the trial equipment is appropriate as the assessment date i.e., December 8, 2017.

Now the vendor is able to bill for the equipment. Due to problems with vendors submitting claims with service dates (e.g., December 2, 2017) that were prior to the assessment date of December 8, 2017 and then rejected, vendors are instructed as per AADL policy not to bill until they have a copy of the 1250 form.

They can then input the service date as the same date as the assessment date or the date they received notification from the authorizer as long as this date is after the assessment date on the 1250 form.

8. 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.

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.

9. Product upcharge

There are two 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.

10. Cost-sharing

Cost-share is based on the client’s family income. If the client’s family income is below a set amount determined each benefit year, they are exempt from cost-share. This can be established using the IVR or e-business. Vendors must charge the client cost share unless the client is cost-share exempt. Once the $500 maximum contribution is reached in a benefit year, AADL will refund overpayment.

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 IVR or e-business to check for cost-share status. 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).

11. Vendors cannot initiate a QFR

Only an authorizer or a specialty supplier can initiate a quality and frequency review request..

12. Vendors cannot bill for their mistakes

Please refer to the AADL General Policies and Procedures. Vendor errors are the financial responsibility of the vendor.

13. Keeping inventory

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

14. Physical records retention

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

  • 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 (e.g., shred or break CDs or diskettes, securely wipe, demagnetize).

15. Satellite clinics

A satellite clinic is a clinic that is not staffed 5 days a week which means 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.