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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Updates on Coverage of Community Health Worker Services

Effective Oct. 1, 2023, Healthfirst will reimburse Community Health Worker (CHW) services for pregnant and postpartum people as a preventive medical service when billed under a Medicaid-enrolled supervising licensed provider. See the provider alert for additional updates.

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Billing
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
New Effective Date for Acupuncture, Occupational Therapy, Physical Therapy, and Speech Therapy Standard Fee Schedule Rates

The effective date for these changes has been delayed from April 1, 2024, to June 1, 2024.

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Reimbursement
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2024
New Prior Authorization Guidelines for Select Services effective July 1, 2024

Effective July 1, 2024, Healthfirst will change its authorization guidelines for select services on the CMS code list. As of that date, the services requiring prior authorization will include laboratory services (managed through eviCore). See the Provider Alert for a list of codes that will now require prior authorization.

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Authorization
  
Provider Alerts - Telehealth - Claims & Billing - Policy, Billing, or Coverage Update - 2023
Telehealth Place of Service Changes

With the ending of the Federal Public Health Emergency, Healthfirst will be aligning with New York State (NYS) and Centers for Medicare & Medicaid Services (CMS) guidance on Telehealth Place of Service (POS) billing and reimbursement.

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Reimbursement
Administration
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Mobile Crisis and Crisis Residence Services: Important Updates and FAQs

New York State received federal approval to consolidate and align its Mobile Crisis and Crisis Residence services effective March 1, 2024.

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Preventative Measures
  
Claims & Billing - Provider Resources - 2024
Healthfirst Clinical Guidelines 2024

Healthfirst wishes to be transparent in the clinical guidelines we use when reviewing authorizations. We are pleased to share a new feature on our Provider Portal: Clinical Guidelines. This tool outlines the clinical criteria Healthfirst uses to support member care decisions. Please note: Guidelines for authorizations managed by our delegated vendors can be found by visiting the respective delegated vendor websites. Please follow the steps outlined in this document to use this helpful new feature.

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Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
New York State Medicaid Guidance for Billing Respiratory Syncytial Virus (RSV) Vaccines

As of Oct. 1, 2023, New York State (NYS) Medicaid began reimbursing NYS Medicaid-enrolled providers for administration or dispensing of Respiratory Syncytial Virus (RSV) vaccines for adults and for the administration of nirsevimab for infants.

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Billing
  
Claims & Billing - Form - 2024
Prior Authorization Request - Podiatry and Peripheral Vascular Disease

Effective Jan. 1, 2024, Healthfirst resumed responsibility for management of prior authorization (PA) requests for Podiatry and Peripheral Vascular Disease. Starting Jan. 1, 2024, you may submit PA requests for these services to Healthfirst for dates of service on or after Jan. 1, 2024, by using this fax form. To submit your request via our Online Authorization tool, visit our Healthfirst Provider Portal at hfproviderportal.org. To create an account, select "Create your account." You may also contact your Healthfirst account manager.

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Prior Authorization
  
Claims & Billing - Form - 2024
Prior Authorization Request - Physical, Occupational, and Speech Therapies

Effective Jan. 1, 2024, Healthfirst has resumed responsibility for management of prior authorization (PA) requests for Physical, Occupational, and Speech Therapies. You may now submit PA requests for these services to Healthfirst for dates of service on or after Jan. 1, 2024. Please download this PDF of the fax request form or visit the Healthfirst Provider Portal at hfproviderportal.org to submit your request using our Online Authorization tool.

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Prior Authorization
  
Provider Alerts - Claims & Billing - Pharmacy Resources & Formularies - Plans & Benefits - Provider Resources - 2023
Inflation Reduction Act Changes to Member Inflation Reduction Act Changes to Member

Healthfirst would like to alert you to new requirements around the Inflation Reduction Act of 2022 (IRA) provisions applicable for 2023 regarding cost sharing for Part B and Part D drugs

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Quality and Compliance
  
Claims & Billing - Policy, Billing, or Coverage Update - 2023
Healthfirst to Manage Some Outpatient Authorization Requests Formerly Handled by OrthoNet

Effective Jan. 1, 2024, Healthfirst will resume responsibility for management of prior authorization (PA) requests for all Physical, Occupational, and Speech Therapies; Podiatry Services, and Vascular Surgery. This FAQ will help you understand how this change might affect you...

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Prior Authorization
  
Provider Alerts - Telehealth - Claims & Billing - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2022
Coronavirus: Telehealth Policies FAQ

Did you know that providers need to be approved by Healthfirst to continue qualifying for reimbursement of telehealth services? Access our FAQs to learn more.

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COVID-19
  
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