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Provider Alerts (Provider Alert) - 2021
COVID-19 Vaccination Update: NYC Residents Ages 65 And Older Can Now Get Vaccinated

Effective immediately, New Yorkers who are over the age of 65 will now be eligible to get a coronavirus vaccine. Access this resource for important information such as what you need to know before getting and/or administrating the vaccine, and much more.

Provider Alerts (Practice Guidelines and Tips) - 2021
Healthfirst Utilization Management

On December 23, 2020, the New York Department of Financial Services (DFS) issued Insurance Circular Letter No. 17, Coronavirus and the Suspension of Certain Utilization Review and Notification Requirements under the “Surge and Flex” Protocol. Access this document to learn about what Healthfirst is doing in response to this protocol and for more information.

Utilization Review

Skilled Nursing Facility

Behavioral Health

Provider Alerts (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

Provider Alerts (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

Provider Alerts (General Update) - 2020
Celebrating Top Performers from the 2019 Healthfirst Quality Incentive Program (HQIP)

Thank you to all our providers for your hard work in the Healthfirst Quality Incentive Program. We would like to recognize the top performers from the 2019 HQIP for achieving the highest overall quality ratings among their peers.

Provider Alerts (Policy, Billing, or Coverage Update) - 2020
Medicare Monoclonal Antibody COVID-19 Infusion Program

On November 9, 2020, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the investigational monoclonal antibody therapy, bamlanivimab, for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients with positive COVID-19 test results who are at high risk for progressing to severe COVID-19 and/or hospitalization.

COVID-19

Medicare

Provider Alerts (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

Provider Alerts (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

Provider Alerts (Provider Alert) - 2020
Healthfirst Drug Formulary Changes: Effective April 1, 2021

Beginning April 1, 2021 instructed by the New York State Department of Health (NYS DOH), Medicaid Managed Care (MMC) plans will be moving the pharmacy benefit into the New York State Fee-for-Service (FFS) program. NYS DOH requires MMCs to align with their formularies by October 1, 2020.

Pharmacy Billing

Formularies

Personal Wellness Plan

Medicaid Managed Care

Provider Alerts (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

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