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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Provider Fee Schedule Corrections

Healthfirst is conducting a routine review and alignment of provider contracts with our system configuration.

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Administration
Reimbursement
  
Provider Alerts - Practice Guidelines and Tips - 2024
Availity Essentials™: Healthfirst’s New Provider Portal Launching July 2024

We are excited to announce that Healthfirst is transitioning to Availity Essentials as our new secure provider portal platform. This transition represents our commitment to continually improving our services and enhancing your overall experience with Healthfirst.

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Administration
  
Provider Alerts - Practice Guidelines and Tips - 2024
Availity Essentials™: Provider Portal Transition FAQ

Starting July 2024, Healthfirst will begin launching our new Provider Portal through Availity Essentials. To ensure a smooth transition, we will continue to update our Frequently Asked Questions (FAQ) document to help you understand how this change will affect you and your practice.

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Administration
  
Provider Alerts - Provider Resources - 2024
Public Health Emergency (PHE) Flexibilities Related to the Medicaid Children’s Waiver and Health Home Services

The New York State Department of Health (NYSDOH) has issued guidance on Public Health Emergency (PHE) flexibilities. This includes important end dates for these flexibilities that providers you should be aware of. Although many emergency flexibilities expired with the official end of the COVID-19 PHE, others have an end date specified by New York State or a maximum period set by the federal government. Find details on all PHE flexibilities here...

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COVID-19
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Updates on Coverage of Community Health Worker Services

Effective Oct. 1, 2023, Healthfirst will reimburse Community Health Worker (CHW) services for pregnant and postpartum people as a preventive medical service when billed under a Medicaid-enrolled supervising licensed provider. Medicaid, HARP, and Connection Plan members are eligible for CHW services during pregnancy and up to 12 months after the end of pregnancy, regardless of how the pregnancy ends. See the provider alert for additional updates.

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Billing
Reimbursement
  
Provider Alerts - General Update - 2024
Healthfirst Availity Clearinghouse Update

Review our Frequently Asked Questions (FAQ) resource dedicated to the Availity Clearinghouse release on March 1st, 2024. We recognize that navigating through new processes and procedures can pose challenges, which is why we've curated this comprehensive list of frequently asked questions to provide you with assistance.

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Availity
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Reimbursement for Adverse Childhood Experiences (ACEs) Screenings

Adverse Childhood Experiences (ACEs) screenings conducted in primary care settings for children and adolescents up to 21 years old are now reimbursable for New York State (NYS) Medicaid fee-for-service (FFS). This change took effect Jan. 1, 2024. Effective April 1, 2024, Healthfirst will reimburse providers who meet the criteria for ACEs screening.

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Administration
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Qualified Dietitians/Nutritionists Can Now Enroll and Bill Directly for Medical Nutritional Therapy

As of Jan. 1, 2024, qualified dietitians/nutritionists are allowed to enroll and bill directly for medically necessary Medical Nutritional Therapy (MNT) provided to eligible members for the following Healthfirst lines of business: Medicaid Managed Care, Personal Wellness Plan, Senior Health Partners Managed Long-Term Care Medicaid Plan, and Healthfirst CompleteCare (HMO D-SNP).

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Administration
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Medicare now covers more family and mental health counseling services

As of January 1, 2024, Medicare covers marriage and family therapy (MFT), mental health counseling (MHC), and intensive outpatient program (IOP) services for all Healthfirst Medicare plans.

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Medicare
  
Provider Alerts - Provider Resources - 2024
Announcing Essential Plan 200–250

Healthfirst is excited to announce our newest benefit plan, Essential Plan 200–250, launching on April 1, 2024. This new plan is part of New York State’s continued efforts to improve health insurance affordability and accessibility. Healthfirst is proud to be the only 5-star-rated Essential Plan in New York State.

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Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
New Effective Date for Acupuncture, Occupational Therapy, Physical Therapy, and Speech Therapy Standard Fee Schedule Rates

The effective date for these changes has been delayed from April 1, 2024, to June 1, 2024.

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Reimbursement
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2024
New Prior Authorization Guidelines for Select Services effective July 1, 2024

Effective July 1, 2024, Healthfirst will change its authorization guidelines for select services on the CMS code list. As of that date, the services requiring prior authorization will include laboratory services (managed through eviCore). See the Provider Alert for a list of codes that will now require prior authorization.

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Authorization