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Provider Alerts (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

Provider Alerts (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

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.

1670 20 2019 HQIP Top Performers List v3 1 FINAL

Provider Alerts (Policy, Billing, or Coverage Update) - 2020
Prior Authorization: Home Visits - Effective February 1, 2021

Effective February 1, 2021, Healthfirst will require prior authorization for the codes listed in the document related to home visits. 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

Prior Authorization: Home Visits - Effective February 1, 2021

Provider Alerts (Policy, Billing, or Coverage Update) - 2021
Authorization Requirement Update for Vision Services

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Authorization

Authorization Requirement Update for Vision Services

Provider Alerts (Policy, Billing, or Coverage Update) - 2021
Removal of Service Limits: Physical Therapy, Occupational Therapy, and Speech Therapy

Starting January 1, 2021, Healthfirst will remove service limits on physical therapy (PT), occupational therapy (OT), and speech therapy (ST). Please note Healthfirst still requires prior authorization and will cover medically necessary PT, OT, and ST visits that are ordered by a doctor or other licensed professional.

Removal of Service Limits: Physical Therapy, Occupational Therapy, and Speech Therapy

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

Healthfirst Utilization Management

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

Healthfirst Reimbursement Policy Updates - Effective February 1, 2021

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

Healthfirst Reimbursement Policy Updates - Effective December 1, 2020

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

1262 20 Provider Alert Adult Flu Codes v5 FINAL

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