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Claims & Billing (Policy, Billing, or Coverage Update) - 2022
Healthfirst Reimbursement Policy Updates - Effective February 1, 2022

Healthfirst aims to ensure that our reimbursement policy standards are compliant with state and national industry standards. Effective February 1, 2022, several changes will be made to our reimbursement policy to maintain compliance with industry-accepted coding and reimbursement practices, as well as state and national regulatory requirements.

Reimbursement

1588 21 Reimbursement Policy updates Feb 2022 Provider Alert FINAL

Claims & Billing (Policy, Billing, or Coverage Update) - 2022
Billing for No-Cost Drugs and Biologicals

Healthfirst requires that providers record all substances administered to patients and that a charge be reported, even for no-cost drugs and biologicals. When this occurs, the provider or qualified healthcare professional should submit a token charge of $0 for the item.

Prior Authorization

Drug Administration

Billing for No-Cost Drugs and Biologicals

Claims & Billing (Policy, Billing, or Coverage Update) - 2021
Transcranial Dopplers: 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, billing, and medical requirements for Transcranial Dopplers (TCD).

Billing

1541 21 Transcranial Dopplers TCD Provider Alert FINAL

Claims & Billing (Policy, Billing, or Coverage Update) - 2021
COVID-19 Testing — Billing Guidance

Healthfirst will cover medically appropriate COVID-19 testing at no cost share during the public health emergency when such testing is ordered by a physician or licensed healthcare professional for the purpose of diagnosis or treatment of COVID-19.

COVID-19

COVID-19 Testing — Billing Guidance

Claims & Billing (Policy, Billing, or Coverage Update) - 2021
Coronavirus: Telehealth Policies FAQ

Did you know that providers need to be approved by Healthfirst to continue qualifying for reimbursement of telehealth services? Access our FAQs to learn more.

COVID-19

Coronavirus: Telehealth Policies FAQ

Claims & Billing (Policy, Billing, or Coverage Update) - 2021
Coronavirus: Type (COVID-19) — Cost-Sharing Waiver

Please be advised that the New York State Department of Financial Services, the New York State Department of Health, and the federal government have directed Healthfirst to waive patient copayments, coinsurance, and deductibles for certain testing and treatment due to the coronavirus (COVID-19) emergency.

COVID-19

Coronavirus: Type (COVID-19) — Cost-Sharing Waiver

Claims & Billing (Policy, Billing, or Coverage Update) - 2015 or Earlier
National Drug Code (NDC) Billing—Policy Update

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National Drug Code (NDC) Billing—Policy Update

Claims & Billing (Forms) - 2021
Superior Vision - Medical Authorization Request Form

Please submit authorization forms for different dates of service and individual members as separate requests.

Authorization

Superior Vision - Medical Authorization Request Form

Claims & Billing (Policy, Billing, or Coverage Update) -
Superior Vision Authorization Requirements

Effective January 1, 2015, these list of codes do not require initial authorization unless done in an outpatient Ambulatory Service Center (ASC). All follow-up services will also require authorization.

Authorization

Superior Vision Authorization Requirements

Claims & Billing (Policy, Billing, or Coverage Update) - 2020
Healthfirst Reimbursement Policy Updates Effective April 1, 2020

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Reimbursement

Healthfirst Reimbursement Policy Updates Effective April 1, 2020

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