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

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.

Healthfirst Reimbursement Policy Updates Effective April 1, 2020

Healthfirst Reimbursement Policy Updates

Healthfirst Reimbursement Policy Updates

Effective November 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.

Prior Authorization: Home Visits - Effective February 1, 2021

Effective February 1, 2021, Healthfirst will require prior authorization for the codes listed in the document related to home visits. Claims for these services and other types of service will not be paid without prior approval. The authorization required for each visit remains open for 30 days.

0077 21 Provider Alert Anesthesia Unit Policy v3 1 FINAL

Anesthesia services (00100–01999) are limited to a specific number of units per member, per provider group, per day. These limits are considered “typical” but may not reflect the actual services provided. If units are billed beyond our established limits, the total units allowed will be adjusted to the assigned maximum allowed; all other units will be denied. However, additional units can be considered for payment with supporting documentation upon appeal.