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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2020
Healthfirst Reimbursement Policy Updates - Effective March 1, 2020

Healthfirst Reimbursement Policy Updates

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Reimbursement
  
Provider Alerts - Practice Guidelines and Tips - 2025
Physician Order Documentation Process for Licensed Home Care Service Agencies

Licensed Home Care Service Agencies (LHCSA) are required to obtain and document a Physician’s Order before providing Personal Care Services and Private Duty Nursing to Senior Health Partner, CompleteCare, and Medicaid Members.

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Licensed Home Care Services Agencies
Administration
Medicaid
Medicare
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Additional Prior Authorization Codes Managed by EyeMed, Effective April 2025

Starting April 1, 2025, EyeMed will manage prior authorization for six new codes.

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Authorization
Dental and/or Vision
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective March 2025

Starting March 20, 2025, Healthfirst will add prior authorization requirements for selected medical services.

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Administration
Authorization
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2025
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective April 2025

Starting April 6, 2025, Healthfirst will add prior authorization requirements for selected medical services. These changes are part of Healthfirst’s ongoing responsibility to evaluate its medical policies compared to the latest scientific evidence and specialty society guidance.

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Administration
Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Changes to the Healthfirst Connection Plan (HMO D-SNP) and Life Improvement Plans Beginning in 2025

Starting January 1, 2025, Providers will need to bill Medicaid Fee-for-Service or Member’s Medicaid Coverage for Healthfirst Connection Plan Members’ cost sharing.

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Medicaid
Medicare
Reimbursement
  
Provider Alerts - Practice Guidelines and Tips - 2024
Scheduling Configuration Changes for Linked and Mutual Visits

Starting January 1, 2025, Healthfirst is creating new service code configurations to accurately account for Linked and Mutual Visits.

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Administration
Authorization
Licensed Home Care Services Agencies
Medicaid
  
Provider Alerts - Provider Resources - 2024
Diabetes Cost-Sharing Reduction for Essential Plan, Leaf Plan, and Leaf Premier Plan Members

Starting January 1, 2025, New York State of Health is implementing a Diabetes Cost-Sharing Reduction initiative to make services more accessible and affordable. Learn more about these cost-sharing reductions in this Provider Alert...

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Cost Sharing
Diabetes
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Changes to Claims Submissions for Prenatal and Postpartum Services

Providers using bundled or global procedure codes for billing perinatal services must submit non-payment category II CPT codes for members in Medicaid, Personal Wellness Plans, Medicaid Advantage Plans, and Connection Plans.

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Medicaid
  
Provider Alerts - Provider Resources - 2024
Changes to the Special Enrollment Period for Dual-Eligible and Low-Income Subsidy Recipients Beginning in 2025

The 2025 Centers for Medicare & Medicaid Services (CMS) Medicare Advantage and Part D Final Rule includes several changes to enrollment for our dual-eligible and Low-Income Subsidy (LIS) members.

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Healthfirst Plans
Medicare
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Prior Authorization No Longer Required for Antiretroviral Prescription Medications

Healthfirst has removed prior authorization requirements from all antiretroviral medications prescribed for the treatment or prevention of Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS) for all Healthfirst plans.

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Authorization
Preventive Measures
Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Crisis Residence and Mobile Crisis Services Now Covered for Healthfirst Essential Plan, Leaf, and Leaf Premier Members

Starting January 1, 2025, Healthfirst will cover Crisis Residence Services and Mobile Crisis Services for our Essential Plan (EP) and Leaf and Leaf Premier Plan members (also known as our Qualified Health Plans). Additionally, these services will continue to be covered under the Medicaid, Personal Wellness Plans (HARP), Child Health Plus (CHPlus), and Medicaid Advantage Plan (MAP) lines of business.

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Medicaid
Behavioral Health and Mental Health
  
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