As the Interim Federal Health Program claims administrator, Medavie Blue Cross administers claims submitted by health care providers and institutions that render necessary services to clients eligible for Pre-Departure Medical Services.
For Panel Physicians, Panel Radiologists and Secondary providers not affiliated with the International Organization for Migration (IOM):
For Panel Physicians and Panel Radiologists who are affiliated with the International Organization for Migration (IOM):
Medical Services Form (PDF, 176 KB)
Use this claim form for individual claim submissions.
Invoice Summary Form (ZIP of PDF, 1.47 MB)
For use by IOM only.
Prior Approval Form (PDF, 177 KB)
Use this claim form for requesting approval as directed in the benefit grid.
Vaccination Manual (PDF, 1.48 MB)
This manual includes essential information for the International Organization for Migration to provide vaccination services to beneficiaries of the Interim Federal Health Program.
Immunization Consent Form (PDF, 376 KB)
For use by the IOM health care providers only. The form must be signed by all IFHP clients receiving vaccinations before each immunization appointment.
Immunization Documentation Form (PDF, 320 KB)
For use by IOM health care providers only.
Benefit Grid (PDF, 383 KB)
Reference this for the rules and/or criteria for billing the PDMS program.