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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2023
Medical Nutrition Therapy Added to the Article 29-I VFCA Health Facilities

In accordance with the approved Medicaid State Plan Amendment: Medical Nutrition Therapy (MNT) has been added to the Article 29-I VFCA Health Facilities (29-I) Other Limited Health Related Services (OLHRS) Fee Schedule. View for more details.

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Billing
  
Provider Alerts - Claims & Billing - Provider Resources - 2023
Pharmacist-Administered Human Papillomavirus (HPV) Vaccine Now Available to Healthfirst Patients Aged 18+

New York law has expanded the types of immunizations licensed pharmacists can administer to patients 18 years or older, including the HPV vaccine.

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Vaccines
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Medicare now covers more family and mental health counseling services

As of January 1, 2024, Medicare covers marriage and family therapy (MFT), mental health counseling (MHC), and intensive outpatient program (IOP) services for all Healthfirst Medicare plans.

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Medicare
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Reimbursement Update for eConsults

The New York State Medicaid fee-for-service program will reimburse for electronic consultations (eConsults) for select plans.

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Administration
Reimbursement
Medicaid
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Provider Fee Schedule Corrections

Healthfirst is conducting a routine review and alignment of provider contracts with our system configuration.

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Administration
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Reimbursement for Adverse Childhood Experiences (ACEs) Screenings

Adverse Childhood Experiences (ACEs) screenings conducted in primary care settings for children and adolescents up to 21 years old are now reimbursable for New York State (NYS) Medicaid fee-for-service (FFS). This change took effect Jan. 1, 2024. Effective April 1, 2024, Healthfirst will reimburse providers who meet the criteria for ACEs screening.

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Administration
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Qualified Dietitians/Nutritionists Can Now Enroll and Bill Directly for Medical Nutritional Therapy

As of Jan. 1, 2024, qualified dietitians/nutritionists are allowed to enroll and bill directly for medically necessary Medical Nutritional Therapy (MNT) provided to eligible members for the following Healthfirst lines of business: Medicaid Managed Care, Personal Wellness Plan, Senior Health Partners Managed Long-Term Care Medicaid Plan, and Healthfirst CompleteCare (HMO D-SNP).

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Administration
  
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
  
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. Medicaid, HARP, and Connection Plan members are eligible for CHW services during pregnancy and up to 12 months after the end of pregnancy, regardless of how the pregnancy ends. See the provider alert for additional updates.

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Billing
Reimbursement
  
Claims & Billing - Patient Care Resources - Video - 2022
Child and Adolescent Behavioral Health in the Primary Care Setting

Project Teach – Maja Castillo, MD, MHA, AVP Pediatric Medical Director, Healthfirst Anxiety in Children & Adolescents – Victoria Johnson, MD, Associate Medical Director, Valera Health Resources and Best Practices: Pediatric Behavioral Health Referrals – Caroline Heindrichs

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Children & Family
  
Claims & Billing - Practice Guidelines and Tips - 2020
Smoking Cessation Counseling Benefit Reimbursement Information and Billing Codes
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Smoking Cessation
  
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