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Provider Alerts (Practice Guidelines and Tips) - 2022
NYSDOH Issues Advisory: Sotrovimab No Longer Authorized to Treat COVID-19 in Any U.S. Region – Pause in Distribution

The New York State Department of Health (NYSDOH) issued an Advisory on March 25, 2022, announcing a pause in the distribution of sotrovimab.

COVID-19

NYSDOH Issues Advisory: Sotrovimab No Longer Authorized to Treat COVID-19 in Any U.S. Region – Pause in Distribution

Provider Alerts (Policy, Billing, or Coverage Update) - 2022
Healthfirst Reimbursement Policy Update

Healthfirst aims to ensure that our reimbursement policy standards are compliant with state and national regulatory requirements and industry standard coding and reimbursement practices. This update describes our reimbursement policy for certain surgical pathology claims.

Reimbursement

Healthfirst Reimbursement Policy Update

Provider Alerts (Practice Guidelines and Tips) - 2022
Cultural Competency Training for Participating Providers

A New York State Department of Health mandate requires that providers and their office staff who have regular and substantial contact with Healthfirst members certify annually the completion of Cultural Competency Training. This requirement applies to all providers participating in the following Healthfirst lines of business:
- Personal Wellness Plan
- Managed Long-Term Care
- Child Health Plus
- Medicaid Advantage Plus
- Medicaid Managed Care

Cultural Competency Training for Participating Providers

Provider Alerts (Policy, Billing, or Coverage Update) - 2022
New York Medicaid COVID-19 Vaccine Claims Submission Reminder

This information is being provided to assist your pharmacy with the submission of COVID-19 vaccine administration claims. The content of this communication is for informational purposes only and is not intended as a substitute for the information provided in the COVID-19 Vaccine Administration Network Enrollment Form.

Medicaid

New York Medicaid COVID-19 Vaccine Claims Submission Reminder

Provider Alerts (Policy, Billing, or Coverage Update) - 2022
New York State Medicaid Coverage Criteria for Pharmacists Providing COVID-19 Vaccine Counseling

The New York State Department of Health issued guidance that New York State Medicaid will reimburse COVID-19 vaccination counseling to Medicaid members/enrollees by pharmacists in order to encourage vaccination against COVID-19. The effective date of coverage is for dates of service on or after December 1, 2021.

Medicaid

Pharmacy Billing

New York State Medicaid Coverage Criteria for Pharmacists Providing COVID-19 Vaccine Counseling

Provider Alerts (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.

Billing

Child HCBS Authorizations and Reminder of State Billing and Claiming Requirements

Provider Alerts (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.

Billing

Billing Guidance for Acupuncturists

Provider Alerts (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.

Prior Authorization

Changes to Authorization Guidelines for Selected Medical Services

Provider Alerts (Policy, Billing, or Coverage Update) - 2022
Healthfirst Reimbursement of Developmental Screening in Primary Care

Effective April 1, 2022, Healthfirst will begin to reimburse Developmental Screening (CPT 96110) in primary care as per New York State Medicaid guidance.

Reimbursement

Healthfirst Reimbursement of Developmental Screening in Primary Care

Provider Alerts (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.

Billing

Healthfirst Policy for the Authorization of Applied Behavioral Analysis (ABA) Services

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