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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-102 Taxonomy

A taxonomy code is a unique 10-character alphanumeric code that signifies a provider’s classification and area of specialization.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-098 Monkeypox Vaccine Coverage

This policy outlines the reimbursement guidelines for coverage of the monkeypox vaccination and administration.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-096 New Physician Dispenser

Effective September 1, 2022, Medicaid pharmacy claims submitted from a physician dispenser will be rejected by Healthfirst’s pharmacy benefit manager, CVS Caremark.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-078 Telemedicine

This policy describes the services covered, provider requirements and reimbursement for Telehealth and Virtual health services.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-101 After Hours and Weekend Care

After hours or weekend care (CPT®) codes represent services provided when a Healthcare Provider is required to render the services outside of regular posted office hours to treat a patient's urgent illness or condition.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-100 Surgical Pathology

Healthfirst has established a policy regarding the number of units payable for surgical pathology services.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-099 Oral Sleep Apnea Device Appliance

Healthcare Common Procedure Coding System (HCPCS) E0485 and E0486 describe oral appliances which are used for the treatment of Obstructive Sleep Apnea (OSA).

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Compliance, Regulatory & Policies - Provider Resources - 2024
The End of the Public Health Emergency, Part 4

The federal Public Health Emergency (PHE) related to the COVID‑19 pandemic ended on May 11, 2023. In this resource, you will find the latest PHE policy and procedure updates that may affect Healthfirst participating providers.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-079 Coronavirus Testing in the Outpatient Setting

Human coronaviruses, first characterized in the 1960s, are named based on the spiked proteins located on their surface.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-050 Hepatitis Testing

Infectious hepatitis is an inflammation of the liver caused by the hepatitis viruses. Hepatitis C is a blood-borne virus that can be spread via sharing needles or other equipment to inject drugs as well as in inadequate infection control in healthcare settings (CDC, 2018).

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-041 Serum Tumor Markers for Malignancies

Tumor biomarkers are proteins detected in the blood, urine, or other body fluids that are either produced by the tumor itself or in response to its presence.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-038 Immunohistochemistry

Immunohistochemistry (IHC) is a very sensitive and specific staining technique that uses anatomical, biochemical, and immunological methods to identify cells, tissues, and organisms by the interaction of target antigens with highly specific monoclonal antibodies and visualization though the use of a biochemical tag or label (Fitzgibbons et al., 2014).

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Reimbursement Policy
  
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