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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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Preventative Measures
  
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 - 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
  
Claims & Billing - Practice Guidelines and Tips - 2023
eviCore Quick Reference Guide

View this eviCore QRG for resources and phone numbers.

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Documentation
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Healthfirst Reimbursement Policy Updates - Effective March 1, 2020

Healthfirst Reimbursement Policy Updates

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Reimbursement
  
Claims & Billing - Policy, Billing, or Coverage Update - 2022
New CMS Modifiers for Distinct Procedural Services (59 Modifier)
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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Transcranial Dopplers: Coding, Billing, and Medical Requirements

To ensure appropriate payments and maintain billing efficiencies, Healthfirst is committed to informing providers of specific requirements for the usage of any medical device. This alert provides guidance on Healthfirst coding, billing, and medical requirements for Transcranial Dopplers (TCD).

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Billing for No-Cost Drugs and Biologicals

Healthfirst requires that providers record all substances administered to patients and that a charge be reported, even for no-cost drugs and biologicals. When this occurs, the provider or qualified healthcare professional should submit a token charge of $0 for the item.

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Prior Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Healthfirst Reimbursement Policy Updates - Effective February 1, 2022

Healthfirst aims to ensure that our reimbursement policy standards are compliant with state and national industry standards. Effective February 1, 2022, 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.

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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Healthfirst Reimbursement Policy Updates - Effective March 1, 2022

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, our reimbursement policy will undergo several changes effective March 1, 2022. These changes will maintain compliance with industry-accepted coding and reimbursement practices, as well as with state and national regulatory requirements.

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Documentation