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

Healthfirst aims to ensure that our reimbursement policy standards are up to date and are compliant with state and national industry standards. Effective September 1, 2021, 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 Update

Healthfirst aims to ensure that our reimbursement policy standards are compliant with state and national regulatory requirements and industry standard coding and reimbursement practices. This update describes our reimbursement policy for certain surgical pathology claims.

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Reimbursement
  
Claims & Billing - Telehealth - Practice Guidelines and Tips - 2022
Guidance for ADHC Telehealth and In-Person Services

Healthfirst offers guidance to Adult Day Health Care (ADHC) providers to successfully obtain authorizations and reimbursement for the following services: - Telehealth Services - In-Person Services Upon Reopening

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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Optos Optomap Imaging: 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 and medical requirements for Optos Optomap imaging.

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
2022 Medicare Advantage Sequestration Reinstatement

Effective April 1, 2022, CMS has reinstituted sequestration reductions to claims payments for Medicare enrollees in accordance with The Protecting Medicare and American Farmers from Sequester Cuts Act.

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Billing
  
Provider Alerts - Claims & Billing - Pharmacy Resources & Formularies - Provider Resources - 2023
Reimbursement Update for SPRAVATO

This notice is to inform providers about reimbursement updates for billing or submitting claims for the SPRAVATO medication.

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
0996 22 Auth for Vision Svcs Provider Alert v7 FINAL

Effective August 1, 2022, Healthfirst no longer requires authorization for the selected vision services listed in this Provider Alert.

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Authorization
  
Provider Alerts - Claims & Billing - Pharmacy Resources & Formularies - Provider Resources - 2023
New Physician Dispenser Policy

After September 1, 2022, Medicaid pharmacy claims submitted from a physician dispenser will be rejected by Healthfirst’s pharmacy benefit manager, CVS Caremark

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Changes to Authorization Guidelines for Selected Services

Effective November 1, 2022, Healthfirst will make changes to its authorization guidelines for selected services. The service codes that newly require a prior authorization include pathology and laboratory services and non-oral and injectable chemotherapy drugs.

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Prior Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2023
Expansion of Lactation Service Coverage

Consistent with new requirements established for NYS Medicaid Managed Care (MMC) plans (including mainstream MMC plans, Human Immunodeficiency Virus (HIV) Special Needs Plans (HIV-SNPs), and Health and Recovery Plans (HARPs)), Healthfirst has expanded lactation services coverage under those plans to include reimbursement eligibility for providers certified by nationally recognized accrediting agencies.

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Medicaid Managed Care
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
1448 22 BH PROS Auth Changes Provider Alert v2 Final WR

Effective Nov. 21, 2022, Healthfirst, in accordance with the State of New York, will no longer require prior authorization for Personalized Recovery Oriented Services (PROS).

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Medicaid Managed Care
  
Claims & Billing - Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Frequently Asked Questions: Healthfirst Laboratory Benefit Management Program

Effective June 1, 2023, Healthfirst will apply updated billing and reimbursement policies to claims reporting laboratory services performed in office, hospital outpatient, and independent laboratory locations. Review these answers to frequently asked questions.

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Policy Reminder
  
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