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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-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
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-036 Immune Cell Function Assay

Immune cell function assays involve measurement of peripheral blood lymphocyte response (intracellular ATP levels, proliferation) following stimulation to assess the degree of functionality of the cell-mediated immune response (Buttgereit et al., 2000).

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-006 Vitamin B12 and Methylmalonic Acid Testing

Vitamin B12, also known as cobalamin, is a water-soluble vitamin required for proper red blood cell formation, key metabolic processes, neurological function, and DNA regulation and synthesis.

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Reimbursement Policy
  
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