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Provider Alerts - Claims & Billing - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2021
Coronavirus: Type (COVID-19) — Cost-Sharing Waiver

Please be advised that the New York State Department of Financial Services, the New York State Department of Health, and the federal government have directed Healthfirst to waive patient copayments, coinsurance, and deductibles for certain testing and treatment due to the coronavirus (COVID-19) emergency.

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COVID-19
  
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
  
Claims & Billing - Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2021
Reimbursement Policy: Anesthesia Start and Stop Times

Healthfirst requires that providers include the start time, stop time, and duration of anesthesia in the note segment of the 5010 claim form.

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Reimbursement
  
Claims & Billing - Practice Guidelines and Tips - 2020
Licensed Home Care Service Agencies (LHCSA) Billing and Authorization Guide
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Authorization
  
Claims & Billing - Practice Guidelines and Tips - 2022
OrthoNet Codes Requiring Authorization
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Authorization
  
Claims & Billing - Practice Guidelines and Tips - 2020
2019 eviCore Radiology and Radiation Therapy Code List
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Authorization
  
Claims & Billing - Policy, Billing, or Coverage Update - 2020
Online Authorization Tool – Requesting Prior Authorization for Medical Benefit Specialty Drugs
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Authorization
  
Claims & Billing - Practice Guidelines and Tips - 2020
Medicaid Smoking Cessation Benefit Reimbursement FAQs
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Smoking Cessation
  
Claims & Billing - Policy, Billing, or Coverage Update - 2021
Policy for Medical Record Documentation Standards

Effective February 1, 2021, consistent with Centers for Medicare & Medicaid Services (CMS) guidelines and the Healthfirst Provider Manual, Healthfirst will require the medical record documentation standards outlined within this document.

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Medical Record Reviews
  
Claims & Billing - Policy, Billing, or Coverage Update - 2021
New CPT® Category III Codes

Healthfirst aims to ensure that our reimbursement policy standards are compliant with state and national industry standards. The American Medical Association (AMA) has released new Category III codes, effective July 1, 2021. As of this date, Healthfirst requires prior authorization for these codes.

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Reimbursement
  
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