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Provider Alerts (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
Provider Alerts (Policy, Billing, or Coverage Update) - 2021
Pharmacy Billing Guidance for COVID-19 Vaccine Under Healthfirst’s Medicaid Managed Care Plan (MMC) and Personal Wellness Plan

Per New York Governor Cuomo’s Executive Order #202, during the declared disaster emergency, pharmacies may bill for COVID-19 vaccines that have been authorized by the FDA under Emergency Use Authorization (EUA) under Healthfirst’s Medicaid Managed Care Plan and Personal Wellness Plan. As additional COVID-19 vaccines become available under an EUA, or are otherwise approved by the FDA, this billing guidance will be updated as needed.
Personal Wellness Plan
  
  
Pharmacy Billing Guidance for COVID-19 Vaccine Under Healthfirst’s Medicaid Managed Care Plan (MMC) and Personal Wellness Plan
Provider Alerts (Policy, Billing, or Coverage Update) - 2021
Transition of the Pharmacy Benefit from Managed Care to Fee-for-Service

Effective May 1, 2021, at the direction of the New York State Department of Health (NYSDOH), Medicaid Managed Care (MMC) plans will move the pharmacy benefit into the NYS Fee-for-Service (FFS) program. To prepare for this change, on March 1, 2021, Healthfirst will transition select physician-administered drugs paid under the pharmacy benefit to the Healthfirst medical benefit.
  
Transition of the Pharmacy Benefit from Managed Care to Fee-for-Service

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