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Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2023
New Prior Authorization Guidelines for Select Services

Effective Nov. 1, 2023, Healthfirst will change its authorization guidelines for select services due to newly created codes on the CMS code list. As of that date, the services requiring prior authorization will include spinal surgery services managed through OrthoNet™, as well as radiation therapy and laboratory services managed through eviCore.

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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 - Policy, Billing, or Coverage Update - 2021
Drug Testing Policy

Healthfirst aims to ensure that our policy standards are up to date and are compliant with state and national industry standards. Effective February 1, 2021, Healthfirst has limited the reimbursement of drug testing as outlined in this document.

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Reimbursement
  
Claims & Billing - Form - 2020
Waiver of Liability Form 2020
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Documentation
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Medicare Coverage Billing Guidance for Intensive Outpatient Programs

As of Jan. 1, 2024, Medicare now covers Intensive Outpatient Services. Learn more about the program and billing requirements here.

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Behavioral Health and Mental Health
Reimbursement
Medicare
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2023
Provider Alert - Cost Sharing for Medicare Part B Drugs

Details regarding cost sharing policy changes due to the Inflation Reduction Act.

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Cost Sharing
  
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 - 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 Provider Alert will help you understand how this change might affect you...

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Prior Authorization
  
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