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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-088v1 National Drug Code Billing Requirements

This policy describes the National Drug Code (NDC) information that is required on professional and outpatient facility drug claims that are reported for reimbursement.

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Reimbursement Policy
  
Provider Alerts - Compliance, Regulatory & Policies - Practice Guidelines and Tips - 2024
New State Requirements for Provider Compliance Programs

New York State has made changes to provider requirements for starting and maintaining compliance programs.

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Quality and Compliance
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-90 ICD-10-CM Excludes1 Notes

Effective 04/01/2024, Healthfirst expects the ICD-10-CM Excludes1 Notes policy in accordance with the ICD-10-CM coding guidelines and the Medicare Claims Processing Manual governed by the Centers for Medicare and Medicaid Services (CMS) to be followed.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-087 General Principles of Lab Test Coverage

The purpose of this policy is to establish the standards and guidelines that Healthfirst follows when determining coverage of lab tests.

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Reimbursement Policy
  
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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Administration
  
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-097 Nurse Practitioners and Physician Assistants

Effective April 1, 2019, Healthfirst will implement changes to its reimbursement policy for nurse practitioners (NPs) and physician assistants (PAs) to better align with existing Centers for Medicare & Medicaid Services (CMS) reimbursement policies regarding these types of physician extenders.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Claims & Billing - Policy, Billing, or Coverage Update - 2023
Frequently Asked Questions: Healthfirst Laboratory Benefit Management Program

Effective June 1, 2023, Healthfirst will apply updated billing and reimbursement policies to claims reporting laboratory services performed in office, hospital outpatient, and independent laboratory locations. Review these answers to frequently asked questions.

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Policy Reminder
  
Provider Alerts - Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
New Reimbursement Policies for Laboratory Services

Effective June 1, 2023, Healthfirst is updating reimbursement policies for laboratory service providers with respect to our new partnership with Avalon.

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Policy Reminder
  
Provider Alerts - Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Provider Alert: Medicaid FFS Enrollment Requirement for Providers

Healthfirst has reinstated the Medicaid Management Information System (MMIS) enrollment requirement.

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Medicaid
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-071v1 Modifier Usage

Modifiers have been defined by the American Medical Association (AMA) and adopted by the Centers for Medicare and Medicaid Services (CMS) to provide additional information regarding the services rendered.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-073v1 Ordering/Referring Provider NPI

The NPI number of the ordering/referring provider should be included in all claim’s submissions to Healthfirst for member service requests. Federal regulations require you to submit HIPAA standard electronic transactions with only your NPI number.

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Reimbursement Policy
  
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