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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 - Claims & Billing - Coronavirus (COVID-19) - Telehealth - 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
  
Provider Alerts - Claims & Billing - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2021
COVID-19 Testing — Billing Guidance

Healthfirst will cover medically appropriate COVID-19 testing at no cost share during the public health emergency when such testing is ordered by a physician or licensed healthcare professional for the purpose of diagnosis or treatment of COVID-19.

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COVID-19
  
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 - 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.

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Reimbursement
  
Provider Alerts - Coding - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Coding Instructions for Co-Surgeons and Team Surgeons

Healthfirst follows the Centers for Medicare & Medicaid Services (CMS) guidance for the use of co-surgeon (-62) and team surgeon (-66) modifiers with claim submissions.

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Billing
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2023
eviCore Medical Oncology HCPCS Codes and Descriptions

All providers who request/order any medical oncology services must secure prior authorization for services before the service is rendered in an office or outpatient setting. View this document for more information.

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Prior Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
Healthfirst Reimbursement Policy Updates Frequency of Trigger Point Injections

Healthfirst aims to ensure that our reimbursement policy standards are compliant with state and national industry standards. As a reminder, Healthfirst does not reimburse more than three (3) trigger point injections in a 90-day period.

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Reimbursement
  
Provider Alerts - Claims & Billing - 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.

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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
Healthfirst Reimbursement Policy Updates Effective April 1, 2020

Healthfirst Reimbursement Policy Updates

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Reimbursement
  
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