Compliance, Regulatory & Policies

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024

Reimbursement Policy: PO-RE-084 Radiological Chest Examination

Healthfirst will no longer reimburse for chest X-Ray procedures with service codes 71045 and 71046 unless there is a diagnosis of pertinent signs, symptoms, or diseases.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024

Reimbursement Policy: PO-RE-083 General Ophthalmological Exams

This reimbursement policy outlines the guidelines for the reimbursement of comprehensive ophthalmological exams and intermediate ophthalmological exams for service codes 92012 and 92014.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

This policy outlines the reimbursement procedures for Vaccines for Children (VFC) at Healthfirst, ensuring compliance with New York State (NYS) Medicaid guidelines.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025

Reimbursement Policy: PO-RE-078 Telemedicine

This policy outlines the guidelines for telemedicine and telehealth services eligible for reimbursement by Healthfirst.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-075 Laboratory Procedures

To be considered for reimbursement, all outpatient laboratory claims should be submitted in accordance with: -AMA CPT and HCPCS coding and ICD-10 diagnosis coding guidelines -Other laboratory and pathology coding guidelines -All applicable regulatory guidelines

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-074 Remote Patient Monitoring and Remote Therapeutic Monitoring

The purpose of this policy is to outline the reimbursement guidelines for Remote Patient Monitoring (RPM) services and Remote Therapeutic Monitoring (RTM) services offered by Healthfirst.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-165 Outpatient Facility and Professional Claim Reimbursement – Lesser-of Methodology

This policy outlines Healthfirst’s standard reimbursement methodology for outpatient facilities and professional claims.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-094 Avoidable Readmission

Healthfirst's Avoidable Readmission reimbursement policy is designed to reduce avoidable readmissions and improve quality of care.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-128 Part B Custodial Services-Skilled Therapy and Vaccine Services

This policy outlines the guidelines for the reimbursement of Skilled Therapy and Vaccine services provided under Medicare Part B for custodial Healthfirst Medicare members.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025

Reimbursement Policy: PO-RE-134 Prenatal and Postpartum Services Cost-Sharing Waiver

Starting January 1, 2025, a new NY State of Health (NYSOH) program under New York’s Section 1332 waiver will enhance access and affordability for pregnant and postpartum Qualified Health Plan (QHP) members.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-126 Diabetes Cost-sharing Waiver

This policy outlines Healthfirst’s reimbursement guidelines regarding the waiver of cost-sharing for Essential Plan (EP) and Qualified Health Plan (QHP) members diagnosed with Type 1, Type 2, or Gestational Diabetes.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-162 Diagnostic Laboratory

This policy outlines Healthfirst's standards and requirements for the reimbursement of diagnostic laboratory services.

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Reimbursement Policy

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Reimbursement Policy: PO-RE-084 Radiological Chest Examination

Reimbursement Policy: PO-RE-083 General Ophthalmological Exams

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Reimbursement Policy: PO-RE-078 Telemedicine

Reimbursement Policy: PO-RE-075 Laboratory Procedures

Reimbursement Policy: PO-RE-074 Remote Patient Monitoring and Remote Therapeutic Monitoring

Reimbursement Policy: PO-RE-165 Outpatient Facility and Professional Claim Reimbursement – Lesser-of Methodology

Reimbursement Policy: PO-RE-094 Avoidable Readmission

Reimbursement Policy: PO-RE-128 Part B Custodial Services-Skilled Therapy and Vaccine Services

Reimbursement Policy: PO-RE-134 Prenatal and Postpartum Services Cost-Sharing Waiver

Reimbursement Policy: PO-RE-126 Diabetes Cost-sharing Waiver

Reimbursement Policy: PO-RE-162 Diagnostic Laboratory

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-084 Radiological Chest Examination

Reimbursement Policy: PO-RE-083 General Ophthalmological Exams

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Reimbursement Policy: PO-RE-078 Telemedicine

Reimbursement Policy: PO-RE-075 Laboratory Procedures

Reimbursement Policy: PO-RE-074 Remote Patient Monitoring and Remote Therapeutic Monitoring

Reimbursement Policy: PO-RE-165 Outpatient Facility and Professional Claim Reimbursement – Lesser-of Methodology

Reimbursement Policy: PO-RE-094 Avoidable Readmission

Reimbursement Policy: PO-RE-128 Part B Custodial Services-Skilled Therapy and Vaccine Services

Reimbursement Policy: PO-RE-134 Prenatal and Postpartum Services Cost-Sharing Waiver

Reimbursement Policy: PO-RE-126 Diabetes Cost-sharing Waiver

Reimbursement Policy: PO-RE-162 Diagnostic Laboratory

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