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.

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.

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.

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.

Provider Alert: Medicaid FFS Enrollment Requirement for Providers

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

Provider-Identified Overpayments

If a provider determines that Healthfirst has overpaid a claim, the provider shall, within 60 days of discovery, send a refund check made out to Healthfirst PHSP, Inc. in the amount of the overpayment. View the provider alert for details.

Healthfirst Health Information Exchange Policies and Procedures

These policies and procedures govern the exchange of information through the health information exchange application (“HIE”) operated by Healthfirst, which allows the exchange of Member Data between and among Healthfirst and certain qualified participating providers. Providers that participate in the HIE may access information about Healthfirst members to coordinate services, improve quality, and manage the cost of care. Updated as of June 1, 2022.

Immunize NY Newsletter Immunize NY Adolescent Special Edition

New York State Public Health Laws and Regulations for Lead Poisoning

Lead Poisoning: Prevention, Identification, and Management in Pregnant Women

NYC Universal Reporting Form