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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective March 2025

Starting March 20, 2025, Healthfirst will add prior authorization requirements for selected medical services.

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Administration
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Changes to the Healthfirst Connection Plan (HMO D-SNP) and Life Improvement Plans Beginning in 2025

Starting January 1, 2025, Providers will need to bill Medicaid Fee-for-Service or Member’s Medicaid Coverage for Healthfirst Connection Plan Members’ cost sharing.

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Medicaid
Medicare
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Pediatric Vaccine Counseling Now Covered for Medicaid and Personal Wellness Plan Members

Healthfirst will reimburse providers for pediatric vaccine counseling visits for Medicaid and Personal Wellness Plan (HARP) members under 21 years of age.

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Medicaid
Vaccines
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Changes to Claims Submissions for Prenatal and Postpartum Services

Providers using bundled or global procedure codes for billing perinatal services must submit non-payment category II CPT codes for members in Medicaid, Personal Wellness Plans, Medicaid Advantage Plans, and Connection Plans.

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Medicaid
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Prior Authorization No Longer Required for Antiretroviral Prescription Medications

Healthfirst has removed prior authorization requirements from all antiretroviral medications prescribed for the treatment or prevention of Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS) for all Healthfirst plans.

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Authorization
Preventive Measures
Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Crisis Residence and Mobile Crisis Services Now Covered for Healthfirst Essential Plan, Leaf, and Leaf Premier Members

Starting January 1, 2025, Healthfirst will cover Crisis Residence Services and Mobile Crisis Services for our Essential Plan (EP) and Leaf and Leaf Premier Plan members (also known as our Qualified Health Plans). Additionally, these services will continue to be covered under the Medicaid, Personal Wellness Plans (HARP), Child Health Plus (CHPlus), and Medicaid Advantage Plan (MAP) lines of business.

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Medicaid
Behavioral Health and Mental Health
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Changes to OASAS Comprehensive Outpatient Treatment Programs and Updated Billing Guidance

The New York State Office of Addiction Service and Supports (OASAS) is implementing several changes to integrate care within the OASAS outpatient clinic regulatory structure, including a merged Comprehensive Outpatient Treatment Program (COP) operating certificate, COP reimbursement updates, and inclusion of Opioid Treatment Program (OTP) bundles into APG methodology.

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Behavioral Health and Mental Health
Reimbursement
Medicaid
Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Enhancing Claims Processing Accuracy with ClaimsXten

ClaimsXten (CXT) is an industry-leading claims editing software that adjudicates claims more efficiently and aligns with Healthfirst standards. Review the provider alert for more information on CXT, including updated frequently asked questions.

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Administration
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2024
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective Jan. 1, 2025

Starting Jan. 1, 2025, Healthfirst will change its authorization guidelines for select CPT and HCPCS codes. See the Provider Alert for a list of codes that will now require prior authorization.

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Administration
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
  
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
  
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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Preventive Measures
  
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