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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
Introducing ClaimsXten™

Effective June 2021, Healthfirst will launch ClaimsXten (CXT), an industry-leading claims-editing software from Change Healthcare that will update and expand on Healthfirst’s current claims-editing processes. CXT will adjudicate claims more efficiently and in a manner that aligns with industry standards.

Change Healthcare

Introducing ClaimsXten™

Claims & Billing (Policy, Billing, or Coverage Update) - 2021
Reimbursement Policy: Anesthesia Start and Stop Times

Healthfirst requires that providers include the start time, stop time, and duration of anesthesia in the note segment of the 5010 claim form.

Reimbursement

0238 21 Reimbursement Policy Anesthesia Start End Time FINAL

Claims & Billing (Policy, Billing, or Coverage Update) - 2021
Healthfirst Reimbursement Policy Updates - Effective June 1, 2021

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, effective June 1, 2021, several changes will be made to our reimbursement policy. These changes will maintain compliance with industry-accepted coding and reimbursement practices, as well as state and national regulatory requirements. Policy updates for: Polysomnography and Sleep Studies, Unattended Polysomnography and Sleep Studies, and Home Polysomnography and Sleep Studies.

Reimbursement

0370 21 Reimbursement Policy Updates for 6121 v5

Claims & Billing (Policy, Billing, or Coverage Update) - 2021
Privileging of Providers to Offer Telehealth Services

Healthfirst has established a policy and application process to enable our network of contracted providers to offer telehealth services to our members to improve access to care and outcomes of care. The policy and application process detailed herein is applicable to all providers and vendors who wish to render telehealth services.

Privileging of Providers to Offer Telehealth Services

Claims & Billing (Policy, Billing, or Coverage Update) - 2021
Coding for UroCuff

Healthfirst requires specific coding to bill for the use of the UroCuff. This applies to all Healthfirst providers for all Healthfirst products.

Coding for UroCuff

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) - 2021
Anesthesia Services Maximum Daily Units

Anesthesia services (00100–01999) are limited to a specific number of units per member, per provider group, per day. These limits are considered “typical” but may not reflect the actual services provided.

If units are billed beyond our established limits, the total units allowed will be adjusted to the assigned maximum allowed; all other units will be denied. However, additional units can be considered for payment with supporting documentation upon appeal.

Reimbursement

0077 21 Provider Alert Anesthesia Unit Policy v3 1 FINAL

Claims & Billing (Policy, Billing, or Coverage Update) - 2021
Ambulance Diagnosis Policy

Per CMS LCD L35162 (Jurisdiction H and L), emergency ambulance services (A0425–A0434) are a covered benefit when the services meet the medical necessity requirements as outlined in the CMS manuals and Federal Register sections listed in the CMS National Coverage Policy section indicated in this document.

Providers should report the most appropriate ICD-10 code that adequately describes the patient’s medical condition at the time of transport as the primary diagnosis. 40TIn addition, a secondary diagnosis must be reported to indicate that transportation by any other means is medically contraindicated.

Reimbursement

0078 21 Provider Alert Ambulance Diagnosis Policy v3 1 FINAL

Claims & Billing (Policy, Billing, or Coverage Update) - 2021
Drug Testing Policy

Healthfirst aims to ensure that our policy standards are up to date and are compliant with state and national industry standards. Effective February 1, 2021, Healthfirst will limit the reimbursement of drug testing as outlined in this document.

Reimbursement

Drug Testing Policy

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