Compliance, Regulatory & Policies

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

Reimbursement Policy: PO-RE-158 Hospital Acquired Conditions (HAC)

Hospital Acquired Conditions (HACs) are serious conditions that develop during an inpatient hospital stay and are considered preventable when proper evidence-based procedures are followed.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-156 Non-Covered Codes – Medicaid Managed Care and Child Health Plus

This policy outlines the reimbursement guidelines for non-covered CPT® and HCPCS codes billed to Healthfirst for Medicaid Managed Care and Child Health Plus.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-155 Non-Covered Codes – Medicare

This policy outlines the reimbursement approach for non-covered Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes submitted by providers participating in Healthfirst Medicare Advantage (MA) plans.

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Reimbursement Policy

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

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 - 2025

Reimbursement Policy: PO-RE-125 Serum Testing for Evidence of Mild Traumatic Brain Injury

Traumatic brain injury (TBI) is characterized by pathologic injuries to the brain resulting from external forces or trauma.

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Reimbursement Policy

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

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. As of 2020, seven coronaviruses are known to infect humans.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-063 General Inflammation Testing

Inflammatory response can occur due to tissue injury and/or various disorders, including arthritis, lupus, and infection.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-137 Appropriate Use of Manifestation Diagnosis Codes

Healthfirst is committed to ensuring accurate and compliant claims submission through the correct use of diagnosis coding, specifically emphasizing the appropriate application of Manifestation Codes.

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Reimbursement Policy

Provider Alerts - Compliance, Regulatory & Policies - Practice Guidelines and Tips - 2025

Important Notice Regarding U.S. Department of Justice Regulations on Sensitive Personal Data

The United States Department of Justice (DOJ) has issued new regulations titled the “Final Rule on Preventing Access to U.S. Sensitive Personal Data and United States Government-Related Data by Countries of Concern”, codified at 28 C.F.R. Part 202.

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Healthfirst Plans

Administration

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

Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

Colorectal cancer (CRC) is the term used to describe the development of cancer in the colon or the rectum.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-067 Evaluation of Dry Eyes

Dry eye disease (dysfunctional tear syndrome, DED) is defined by the Dry Eye Workshop II as “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-066 Prescription Medication and Illicit Drug Testing in the Outpatient Setting

Abuse of both prescription and illicit drugs is extremely common.

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Reimbursement Policy

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Reimbursement Policy: PO-RE-158 Hospital Acquired Conditions (HAC)

Reimbursement Policy: PO-RE-156 Non-Covered Codes – Medicaid Managed Care and Child Health Plus

Reimbursement Policy: PO-RE-155 Non-Covered Codes – Medicare

Reimbursement Policy: PO-RE-102 Taxonomy

Reimbursement Policy: PO-RE-125 Serum Testing for Evidence of Mild Traumatic Brain Injury

Reimbursement Policy: PO-RE-079 Coronavirus Testing in the Outpatient Setting

Reimbursement Policy: PO-RE-063 General Inflammation Testing

Reimbursement Policy: PO-RE-137 Appropriate Use of Manifestation Diagnosis Codes

Important Notice Regarding U.S. Department of Justice Regulations on Sensitive Personal Data

Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

Reimbursement Policy: PO-RE-067 Evaluation of Dry Eyes

Reimbursement Policy: PO-RE-066 Prescription Medication and Illicit Drug Testing in the Outpatient Setting

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-158 Hospital Acquired Conditions (HAC)

Reimbursement Policy: PO-RE-156 Non-Covered Codes – Medicaid Managed Care and Child Health Plus

Reimbursement Policy: PO-RE-155 Non-Covered Codes – Medicare

Reimbursement Policy: PO-RE-102 Taxonomy

Reimbursement Policy: PO-RE-125 Serum Testing for Evidence of Mild Traumatic Brain Injury

Reimbursement Policy: PO-RE-079 Coronavirus Testing in the Outpatient Setting

Reimbursement Policy: PO-RE-063 General Inflammation Testing

Reimbursement Policy: PO-RE-137 Appropriate Use of Manifestation Diagnosis Codes

Important Notice Regarding U.S. Department of Justice Regulations on Sensitive Personal Data

Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

Reimbursement Policy: PO-RE-067 Evaluation of Dry Eyes

Reimbursement Policy: PO-RE-066 Prescription Medication and Illicit Drug Testing in the Outpatient Setting

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