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Claims & Billing (Policy, Billing, or Coverage Update) - 2020
Healthfirst Reimbursement Policy Updates - Effective February 1, 2021

Effective February 1, 20201, 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

Claims & Billing (Policy, Billing, or Coverage Update) - 2020
Prior Authorization: Home Care Services - Effective February 1, 2021

Effective February 1, 2021, Healthfirst will require prior authorization for the codes listed in the document related to home care services. Claims for these services and other types of service will not be paid without prior approval. The authorization required for each visit remains open for 30 days.

Prior Authorization

Claims & Billing (Form) - 2020
Waiver of Liability Form

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Claims & Billing (Provider Alert) - 2020
eviCore Healthfirst Provider Orientation Schedule (Nov 2020 to Jan 2021)

eviCore healthcare has been selected to provide utilization management services for the Healthfirst Lab Management Program. The program will begin accepting authorization requests on January 1, 2021 for dates of service on January 1, 2021 and later. eviCore healthcare will lead orientation sessions designed to assist you and your staff with the new utilization management programs. During these sessions we will discuss in detail the prior authorization requirements for each program and how to navigate the eviCore website at evicore.com.

Laboratory Services

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

Effective December 1, 2020, 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

Claims & Billing (Policy, Billing, or Coverage Update) - 2020
eviCore Prior Authorization Procedure List

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Prior Authorization

eviCore

Claims & Billing (Policy, Billing, or Coverage Update) - 2020
2020–2021 Seasonal Influenza Vaccine Codes

Based on the August 2020 guidance from the Centers for Disease Control and Prevention (CDC), the enclosed CPT influenza vaccine codes reflect updates to the 2019–2020 recommendations on the use of seasonal influenza vaccines in the United States from the Advisory Committee on Immunization Practices (ACIP).

Annual Flu Vaccine

Claims

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

Effective November 1, 2020, 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

Claims & Billing (Policy, Billing, or Coverage Update) - 2020
Prior Authorization: Molecular & Genomic Testing Procedure Codes and Descriptions

Healthfirst is pleased to announce our partnership with eviCore to provide authorization services for Genetic and Molecular laboratory services requested for our members enrolled in Medicare, Medicaid, and Commercial plans for dates of service beginning January 1, 2021. Learn more here.

eviCore

Prior Authorization

Billing

Laboratory Services

Claims & Billing (Policy, Billing, or Coverage Update) - 2020
Non-Dental Practitioner Application of Fluoride Varnish in a Primary Care Setting

Effective August 1, 2020 for fee-for-service (FFS) and October 1, 2020 for Medicaid Managed Care (MMC), fluoride varnish can be applied by multiple primary provider types, based on scope of practice, to optimize treatment. This policy applies to mainstream MMC plans and HIV Special Needs Plans.

Reimbursement

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