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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Healthfirst Reimbursement Policy Updates - Effective March 1, 2022

As a part of Healthfirst’s continuing efforts to ensure that our reimbursement policy standards are up to date and compliant with state and national industry standards, our reimbursement policy will undergo several changes effective March 1, 2022. These changes will maintain compliance with industry-accepted coding and reimbursement practices, as well as with state and national regulatory requirements.

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Documentation
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Changes to Authorization Guidelines for Selected Medical Services

Effective April 1, 2022, Healthfirst will change its authorization guidelines for selected medical services. These changes are part of Healthfirst’s ongoing responsibility to evaluate its medical policies compared to the latest scientific evidence and specialty society guidance.

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Prior Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Healthfirst Policy for the Authorization of Applied Behavioral Analysis (ABA) Services

Healthfirst’s medical policies are intended to provide guidance in the administration of Healthfirst’s benefit plans and are used by medical directors and other clinical professionals in making medical necessity and other coverage determinations. This policy is applicable to the Commercial Plan, Qualified Health Plan (QHP), Essential Plan (EP) and Child Health Plus (CHP). While this service is not covered by Healthfirst Medicaid Managed Care Plan, ABA services are available to Medicaid beneficiaries through Medicaid Fee-for-Service.

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Billing Guidance for Acupuncturists

Medicare covers acupuncture for chronic lower back pain. Plans must offer this benefit and can choose to offer a supplemental benefit in addition to the original Medicare-covered visits. Previously, most Healthfirst providers submitted claims for acupuncture visits using ICD-10 M54.5. However, this ICD was retired on October 1, 2021.

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Billing
  
Provider Alerts - Claims & Billing - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2022
Child HCBS Authorizations and Reminder of State Billing and Claiming Requirements

This notice is to remind Children’s Home and Community-Based Services (HCBS) providers of HCBS billing and claiming requirements, per the April 4, 2022, NYSDOH memo.

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Billing
  
Claims & Billing - Telehealth - Practice Guidelines and Tips - 2022
Guidance for ADHC Telehealth and In-Person Services

Healthfirst offers guidance to Adult Day Health Care (ADHC) providers to successfully obtain authorizations and reimbursement for the following services: - Telehealth Services - In-Person Services Upon Reopening

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Reimbursement
  
Provider Alerts - Coding - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Coding Instructions for Co-Surgeons and Team Surgeons

Healthfirst follows the Centers for Medicare & Medicaid Services (CMS) guidance for the use of co-surgeon (-62) and team surgeon (-66) modifiers with claim submissions.

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Optos Optomap Imaging: Coding, Billing, and Medical Requirements

To ensure appropriate payments and maintain billing efficiencies, Healthfirst is committed to informing providers of specific requirements for the usage of any medical device. This alert provides guidance on Healthfirst coding and medical requirements for Optos Optomap imaging.

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
2022 Medicare Advantage Sequestration Reinstatement

Effective April 1, 2022, CMS has reinstituted sequestration reductions to claims payments for Medicare enrollees in accordance with The Protecting Medicare and American Farmers from Sequester Cuts Act.

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Billing
  
Provider Alerts - Pharmacy Resources & Formularies - Claims & Billing - Provider Resources - 2023
Reimbursement Update for SPRAVATO

This notice is to inform providers about reimbursement updates for billing or submitting claims for the SPRAVATO medication.

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
0996 22 Auth for Vision Svcs Provider Alert v7 FINAL

Effective August 1, 2022, Healthfirst no longer requires authorization for the selected vision services listed in this Provider Alert.

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Authorization
  
Provider Alerts - Pharmacy Resources & Formularies - Claims & Billing - Provider Resources - 2023
New Physician Dispenser Policy

After September 1, 2022, Medicaid pharmacy claims submitted from a physician dispenser will be rejected by Healthfirst’s pharmacy benefit manager, CVS Caremark

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Billing
  
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