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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Healthfirst Reimbursement Policy Updates - Effective February 1, 2022

Healthfirst aims to ensure that our reimbursement policy standards are compliant with state and national industry standards. Effective February 1, 2022, several changes will be made to our reimbursement policy to maintain compliance with industry-accepted coding and reimbursement practices, as well as state and national regulatory requirements.

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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2020
Healthfirst Reimbursement Policy Updates - Effective February 1, 2021

Effective February 1, 20201, several changes will be made to our reimbursement policy to maintain compliance with industry-accepted coding and reimbursement practices as well as state and national regulatory requirements.

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Reimbursement
  
Provider Alerts - Coding - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Coding Instructions for Co-Surgeons and Team Surgeons

Healthfirst follows the Centers for Medicare & Medicaid Services (CMS) guidance for the use of co-surgeon (-62) and team surgeon (-66) modifiers with claim submissions.

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Billing
  
Provider Alerts - Coding - Policy, Billing, or Coverage Update - 2023
Acceptable Procedure Code/Modifier Combinations

Effective Sept. 1, 2023, Healthfirst is updating internal systems to deny procedure code/modifier combinations that are specifically flagged as invalid or inactive. These changes are based on New York State Medicaid (NYSM), American Medical Association (AMA), and Centers for Medicare & Medicaid Services (CMS) guidelines.

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Coding
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2023
eviCore Medical Oncology HCPCS Codes and Descriptions

All providers who request/order any medical oncology services must secure prior authorization for services before the service is rendered in an office or outpatient setting. View this document for more information.

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Prior Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
Healthfirst Reimbursement Policy Updates Frequency of Trigger Point Injections

Healthfirst aims to ensure that our reimbursement policy standards are compliant with state and national industry standards. As a reminder, Healthfirst does not reimburse more than three (3) trigger point injections in a 90-day period.

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

Effective December 1, 2020, several changes will be made to our reimbursement policy to maintain compliance with industry-accepted coding and reimbursement practices as well as state and national regulatory requirements.

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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
Healthfirst Reimbursement Policy Updates Effective April 1, 2020

Healthfirst Reimbursement Policy Updates

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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Healthfirst Reimbursement Policy Updates - Effective March 1, 2020

Healthfirst Reimbursement Policy Updates

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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
Healthfirst Reimbursement Policy Updates

Effective November 1, 2021, several changes will be made to our reimbursement policy to maintain compliance with industry-accepted coding and reimbursement practices, as well as state and national regulatory requirements.

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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
Prior Authorization: Home Visits - Effective February 1, 2021

Effective February 1, 2021, Healthfirst will require prior authorization for the codes listed in the document related to home visits. Claims for these services and other types of service will not be paid without prior approval. The authorization required for each visit remains open for 30 days.

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Prior Authorization
  
Provider Alerts - Coronavirus (COVID-19) - Practice Guidelines and Tips - 2021
Healthfirst Utilization Management

On December 23, 2020, the New York Department of Financial Services (DFS) issued Insurance Circular Letter No. 17, Coronavirus and the Suspension of Certain Utilization Review and Notification Requirements under the “Surge and Flex” Protocol. Access this document to learn about what Healthfirst is doing in response to this protocol and for more information.

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Utilization Review
  
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