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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
0077 21 Provider Alert Anesthesia Unit Policy v3 1 FINAL

Anesthesia services (00100–01999) are limited to a specific number of units per member, per provider group, per day. These limits are considered “typical” but may not reflect the actual services provided. If units are billed beyond our established limits, the total units allowed will be adjusted to the assigned maximum allowed; all other units will be denied. However, additional units can be considered for payment with supporting documentation upon appeal.

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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
0078 21 Provider Alert Ambulance Diagnosis Policy v3 1 FINAL

Per CMS LCD L35162 (Jurisdiction H and L), emergency ambulance services (A0425–A0434) are a covered benefit when the services meet the medical necessity requirements as outlined in the CMS manuals and Federal Register sections listed in the CMS National Coverage Policy section indicated in this document. Providers should report the most appropriate ICD-10 code that adequately describes the patient’s medical condition at the time of transport as the primary diagnosis. 40TIn addition, a secondary diagnosis must be reported to indicate that transportation by any other means is medically contraindicated.

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Reimbursement
  
Provider Alerts - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2022
COVID-19 Coding Update for CPT 99072

Healthfirst aims to ensure that our reimbursement policy standards are up to date and compliant with state and national industry standards. Effective immediately, Healthfirst will not reimburse for CPT code 99072.

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COVID-19
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
0370 21 Reimbursement Policy Updates for 6121 v5

As a part of Healthfirst’s continuing efforts to ensure that our reimbursement policy standards are up to date and compliant with state and national industry standards, effective June 1, 2021, several changes will be made to our reimbursement policy. These changes will maintain compliance with industry-accepted coding and reimbursement practices, as well as state and national regulatory requirements. Policy updates for: Polysomnography and Sleep Studies, Unattended Polysomnography and Sleep Studies, and Home Polysomnography and Sleep Studies.

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Reimbursement
  
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 - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2021
Delayed: Applied Behavioral Analysis (ABA) Benefit Carve Out

The October 1, 2021 Applied Behavioral Analysis (ABA) benefit carve out into Managed Medicaid has officially been postponed by New York State Department of Health. Providers should continue to submit claims for ABA services to Medicaid Fee-For-Service directly until further notice.

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Medicaid
  
Provider Alerts - Quality Program Resources - General Update - 2022
Celebrating Top Performers from the 2020 Healthfirst Quality Incentive Program (HQIP)

Thank you to all our providers for your hard work in the Healthfirst Quality Incentive Program. We would like to recognize the top performers from the 2020 HQIP for achieving the highest overall quality ratings among their peers.

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HQIP
  
Provider Alerts - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2023
Billing Guidance for COVID-19 Vaccine Under Healthfirst’s Plans

Healthfirst continues to monitor COVID-19 vaccine updates from the state and federal government and from other healthcare agencies. This guidance provides billing information on COVID-19 vaccines. (Updated June 2023)

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Transcranial Dopplers: Coding, Billing, and Medical Requirements

To ensure appropriate payments and maintain billing efficiencies, Healthfirst is committed to informing providers of specific requirements for the usage of any medical device. This alert provides guidance on Healthfirst coding, billing, and medical requirements for Transcranial Dopplers (TCD).

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Billing
  
Provider Alerts - Claims & Billing - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2021
Coronavirus: Type (COVID-19) — Cost-Sharing Waiver

Please be advised that the New York State Department of Financial Services, the New York State Department of Health, and the federal government have directed Healthfirst to waive patient copayments, coinsurance, and deductibles for certain testing and treatment due to the coronavirus (COVID-19) emergency.

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COVID-19
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Billing for No-Cost Drugs and Biologicals

Healthfirst requires that providers record all substances administered to patients and that a charge be reported, even for no-cost drugs and biologicals. When this occurs, the provider or qualified healthcare professional should submit a token charge of $0 for the item.

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Prior Authorization
  
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