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Plans & Benefits - Practice Guidelines and Tips - 2024
Healthfirst at a Glance - Leaf and Leaf Premier

Our Leaf and Leaf Premier plans offer two levels of coverage for individuals and families. They are Qualified Health Plans certified by the NYSOH marketplace.

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At a Glance
  
Quality Program Resources - Patient Care Resources - Plans & Benefits - Provider Resources - 2024
2024 Special Needs Plan (SNP) Model of Care (MOC) Provider Training

This presentation will help educate providers, delegated vendors, and appropriate staff on the Healthfirst Special Needs Plan (SNP) Model of Care (MOC), the goal of which is to enhance member health outcomes through the use of an integrated care delivery system.

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Special Needs Plan
  
Plans & Benefits - Policy, Billing, or Coverage Update - 2021
Medical Necessity Form (MNF) Form FAQs

Effective May 1, 2021, providers must fill out a Medical Necessity Form (MNF) to schedule Advanced Life Support (ALS) or Basic Life Support (BLS) non-emergent transportation for Healthfirst members to any provider approved by the Centers for Medicare & Medicaid Services (CMS). Here are some frequently asked questions.

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Medicare
  
Provider Alerts - Claims & Billing - Pharmacy Resources & Formularies - Plans & Benefits - Provider Resources - 2023
Inflation Reduction Act Changes to Member Inflation Reduction Act Changes to Member

Healthfirst would like to alert you to new requirements around the Inflation Reduction Act of 2022 (IRA) provisions applicable for 2023 regarding cost sharing for Part B and Part D drugs

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Quality and Compliance
  
Provider Alerts - Plans & Benefits - Policy, Billing, or Coverage Update - 2023
Signature Medicare by Healthfirst - Out-of-Network Providers’ QRG

This Medicare Advantage plan offers additional benefits on top of Original Medicare, like dental, vision, hearing, and fitness. Members have the option of going in-network or out-of-network and visiting any doctor and hospital in the U.S. that accepts Medicare. Out-of-network providers may reference this QRG for more information.

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Signature (PPO)
  
Provider Alerts - Claims & Billing - Pharmacy Resources & Formularies - Plans & Benefits - Policy, Billing, or Coverage Update - 2023
Transition of the Pharmacy Benefit from Managed Care to Fee-for-Service

Effective April 1, 2023, Medicaid members enrolled in Medicaid Managed Care (MMC) Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) will receive their pharmacy benefits through the NYRx Pharmacy program, formerly known as the NYS Fee-for-Service (FFS) Pharmacy program.

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Pharmacy
  
Provider Alerts - Plans & Benefits - Patient Resource - 2023
Provider Alert - 2023 FPL Expansion

Thanks to expanded eligibility, more Medicare beneficiaries will qualify for the Medicare Savings Program (MSP) in 2023.

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Medicare
  
Provider Alerts - Plans & Benefits - Policy, Billing, or Coverage Update - 2023
Important: Recertifications are Resuming in 2023

New York State will resume eligibility reviews and renewals for members of with a recertification date after June 2023. If your patients do not renew on time, they risk losing health coverage and could face unexpected costs or even a gap in care. This Provider Alert contains instructions on how members can renew their coverage...

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Recertification
  
Provider Alerts - Behavioral Health and Foster Care - Plans & Benefits - Practice Guidelines and Tips - 2023
FAQ: Health and Recovery Plans (HARP) and Healthfirst’s Personal Wellness Plan (PWP)

See answers to frequently asked questions about Health and Recovery Plans and Healthfirst’s Personal Wellness Plan.

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HARP Health And Recovery Plan
  
Plans & Benefits - Practice Guidelines and Tips - 2023
2023 Healthfirst Plans at a Glance

Healthfirst has health plans for all New Yorkers.

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At a Glance
  
Plans & Benefits - Practice Guidelines and Tips - 2023
Healthfirst Member ID Cards

View Healthfirst Member ID Cards at a glance.

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At a Glance
  
Plans & Benefits - Practice Guidelines and Tips - 2023
Provider Resource Guide

This resource provides relevant information to assist you in working with Healthfirst and our members.

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At a Glance