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).

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.

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.

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.

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

Smoking Cessation Counseling Benefit Reimbursement Information and Billing Codes

Institutional Services Split Claims Billing Instructions for Medicare Fee-For-Service (FFS) Claims

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.

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.

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.

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.