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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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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-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-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-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 - Policy, Billing, or Coverage Update - 2024

Reimbursement Policy: PO-RE-104 Principal and Chronic Care Management

This policy outlines Healthfirst reimbursement guidelines for Principal and Chronic Care Management (PCM and CCM) services in an outpatient setting.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-106 e-Consult Visits

This document describes the e-Consult visit policy Healthfirst Utilization Management follows when reimbursing for services provided by contracted providers.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-107 Point of Care Ultrasound

This document describes the policy Healthfirst follows for Point of Care Ultrasound (PoCUS). This policy is executed pursuant to applicable provisions set forth in the contracts for the products indicated above, Articles 44 and 49 of the New York State (NYS) Public Health Law (PBH), as well as applicable Federal and State statutes and regulations.

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Reimbursement Policy

Claims & Billing - Compliance, Regulatory & Policies - 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

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023

Reimbursement Policy: PO-RE-021 Testing for Diagnosis of Active or Latent Tuberculosis

Infection by Mycobacterium tuberculosis (Mtb) results in a wide range of clinical presentations dependent upon the site of infection from classic signs and symptoms of pulmonary disease (cough greater than two to three weeks' duration, lymphadenopathy, fevers, night sweats, weight loss) to silent infection with a complete absence of signs or symptoms (Lewinsohn et al., 2017).

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023

Reimbursement Policy: PO-RE-028 Measurement of Thromboxane Metabolites for ASA Resistance

Thromboxane A2 (TXA2) is a metabolite that causes platelet activation in the cyclooxygenase metabolic pathway (Abrams, 2023).

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Reimbursement Policy

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Reimbursement Policy: PO-RE-099 Oral Sleep Apnea Device Appliance

Reimbursement Policy: PO-RE-096 New Physician Dispenser

Reimbursement Policy: PO-RE-098 Monkeypox Vaccine Coverage

Reimbursement Policy: PO-RE-102 Taxonomy

Reimbursement Policy: PO-RE-097 Nurse Practitioners and Physician Assistants

Reimbursement Policy: PO-RE-104 Principal and Chronic Care Management

Reimbursement Policy: PO-RE-106 e-Consult Visits

Reimbursement Policy: PO-RE-107 Point of Care Ultrasound

Frequently Asked Questions: Healthfirst Laboratory Benefit Management Program

New Reimbursement Policies for Laboratory Services

Reimbursement Policy: PO-RE-021 Testing for Diagnosis of Active or Latent Tuberculosis

Reimbursement Policy: PO-RE-028 Measurement of Thromboxane Metabolites for ASA Resistance

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-099 Oral Sleep Apnea Device Appliance

Reimbursement Policy: PO-RE-096 New Physician Dispenser

Reimbursement Policy: PO-RE-098 Monkeypox Vaccine Coverage

Reimbursement Policy: PO-RE-102 Taxonomy

Reimbursement Policy: PO-RE-097 Nurse Practitioners and Physician Assistants

Reimbursement Policy: PO-RE-104 Principal and Chronic Care Management

Reimbursement Policy: PO-RE-106 e-Consult Visits

Reimbursement Policy: PO-RE-107 Point of Care Ultrasound

Frequently Asked Questions: Healthfirst Laboratory Benefit Management Program

New Reimbursement Policies for Laboratory Services

Reimbursement Policy: PO-RE-021 Testing for Diagnosis of Active or Latent Tuberculosis

Reimbursement Policy: PO-RE-028 Measurement of Thromboxane Metabolites for ASA Resistance

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