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Provider Alerts - Coronavirus (COVID-19) - Practice Guidelines and Tips - 2023
Medicaid Members Under Age 19 are Eligible for the Vaccines for Children Program

Children under age 19 can receive the COVID‑19 vaccine at Vaccines for Children (VFC)‑enrolled providers, including their practitioner’s office, public health clinics, most county health departments, and any Medicaid‑ or VFC‑enrolled pharmacy.

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Medicaid
  
Provider Alerts - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
Pharmacy Billing Guidance for COVID-19 Vaccine Under Healthfirst’s Medicaid Managed Care Plan (MMC) and Personal Wellness Plan

During the declared State of New York disaster emergency, pharmacies may bill for COVID-19 vaccines that have been authorized by the FDA under Emergency Use Authorization (EUA) under Healthfirst’s Medicaid Managed Care Plan (MMC) and Personal Wellness Plan (PWP). View PDF for billing instructions.

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Personal Wellness Plan
  
Provider Alerts - Coronavirus (COVID-19) - General Update - 2022
COVID-19 Vaccine Counseling Program

In accordance with Medicaid COVID-19 vaccine regulations, Healthfirst will reimburse eligible providers for vaccine counseling rendered to unvaccinated Medicaid and HARP members/enrollees during dates of service on or after December 1, 2021. For providers located in New York City, this coverage essentially replaces the Vaccine Outreach and Counseling Program (VOCP) Healthfirst launched in collaboration with the New York City Department of Mental Hygiene in the fall of 2021, and which ended on December 31, 2021. If you provided services under the VOCP and have not yet billed for them, please bill in accordance with the requirements of the VOCP

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COVID-19
  
Provider Alerts - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
COVID-19 Vaccine Additional Doses for Immunocompromised Individuals Pharmacy Billing Guidance

On August 13, 2021, the Advisory Committee on Immunization Practices (ACIP) met and recommended an additional dose for immunocompromised individuals who have received the Pfizer-BioNTech or Moderna COVID-19 vaccine.

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Emergency Use Authorization
  
Provider Alerts - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
Pfizer-BioNtech, and Moderna, COVID-19 Booster Update Pharmacy Billing Guidance

The U.S. Food and Drug Administration has amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine and Moderna COVID-19 Vaccine to allow for a booster dose. Consult the individual EUA’s for current guidance.

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Emergency Use Authorization
  
Provider Alerts - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
Zero-Cost COVID-19 Oral Antivirals Pharmacy Billing Guidance

Claims that providers submit for zero-cost COVID-19 oral antivirals must have either $0.01 in the Ingredient Cost Submitted field (NCPDP field 4Ø9-D9) or the combination of $0.00 in the Ingredient Cost Submitted field (NCPDP field 4Ø9-D9) and a value of “15” in the Basis of Cost Determination field (NCPDP field 423-DN).

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Pharmacy Billing
  
Provider Alerts - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
New York Medicaid Guidance for At-Home COVID-19 Testing Coverage Update

Implementation of adjudication coding for at-home testing coverage for most New York Medicaid Managed Care Plan Sponsors should be completed by January 17, 2022. Providers receiving a reject message (e.g., reject code: 70 - NDC not covered, etc.) on COVID-19 at-home testing claims filled prior to January 17, 2022, should re-submit rejected claims after January 17, 2022.

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Pharmacy Billing
  
Provider Alerts - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2022
New York Medicaid Guidance for Billing Monoclonal Antibody Treatments

New York State (NYS) Medicaid will reimburse NY Medicaid-enrolled pharmacies for administration or dispensing of COVID-19 therapeutics, including monoclonal antibody (mAb) treatments with no member cost share.

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COVID-19
  
Provider Alerts - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
New York State Medicaid Coverage Criteria for Pharmacists Providing COVID-19 Vaccine Counseling

The New York State Department of Health issued guidance that New York State Medicaid will reimburse COVID-19 vaccination counseling to Medicaid members/enrollees by pharmacists in order to encourage vaccination against COVID-19. The effective date of coverage is for dates of service on or after December 1, 2021.

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Medicaid
  
Provider Alerts - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
New York Medicaid COVID-19 Vaccine Claims Submission Reminder

This information is being provided to assist your pharmacy with the submission of COVID-19 vaccine administration claims. The content of this communication is for informational purposes only and is not intended as a substitute for the information provided in the COVID-19 Vaccine Administration Network Enrollment Form.

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Medicaid
  
Provider Alerts - Coronavirus (COVID-19) - Practice Guidelines and Tips - 2022
NYSDOH Issues Advisory: Sotrovimab No Longer Authorized to Treat COVID-19 in Any U.S. Region – Pause in Distribution

The New York State Department of Health (NYSDOH) issued an Advisory on March 25, 2022, announcing a pause in the distribution of sotrovimab.

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COVID-19
  
Coronavirus (COVID-19) - Patient Care Resources - Practice Guidelines and Tips - 2022
The Flu and COVID-19 Frequently Asked Questions

Now that flu season is approaching, it's important to remember that the COVID-19 pandemic is still continuing around the world.

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Seasonal Flu
  
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