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Provider Alerts - Provider Resources - 2022
Healthfirst Connection Plan (HMO D-SNP) Announcement

Starting Jan. 1, 2024, Healthfirst will begin covering members in Healthfirst Connection Plan (HMO D-SNP), our newest Medicare Advantage Dual-Eligible Special Needs Plan. Read the Provider Alert for more details...

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Connection Plan
  
Provider Alerts - Compliance, Regulatory & Policies - Practice Guidelines and Tips - 2024
New State Requirements for Provider Compliance Programs

New York State has made changes to provider requirements for starting and maintaining compliance programs.

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Quality and Compliance
  
Provider Alerts - Policy, Billing, or Coverage Update - 2024
Mobile Crisis and Crisis Residence Service Changes

To improve access to crisis care, New York State received federal approval to consolidate and align its Mobile Crisis and Crisis Residence services. These Crisis Intervention State Plan Amendment (SPA) changes will start March 1, 2024.

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Preventive Measures
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Mobile Crisis and Crisis Residence Services: Important Updates and FAQs

New York State received federal approval to consolidate and align its Mobile Crisis and Crisis Residence services effective March 1, 2024.

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Preventive Measures
  
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 - Policy, Billing, or Coverage Update - 2024
Expanded Spinal Muscular Atrophy (SMA) Carrier Screening

New York State (NYS) Medicaid has provided coverage for Spinal Muscular Atrophy (SMA) carrier screening since 2014. However, effective October 1, 2023, the coverage criteria for SMA carrier screening has been expanded to all NYS Medicaid members who are planning to become, or already are pregnant.

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Preventive Measures
  
Provider Alerts - Policy, Billing, or Coverage Update - 2024
Healthfirst CompleteCare and Senior Health Partners Changes to Non-Emergency Transportation Benefits

Healthfirst CompleteCare (HMO D-SNP) and Senior Health Partners (SHP) Changes to Non-Emergency Transportation Benefits, Effective March 1, 2024. Services now available through NYS Medical Answering Services (MAS).

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Healthfirst Plans
  
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
  
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 - 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 - Policy, Billing, or Coverage Update - 2022
Coverage of Lung Cancer Screening with Low Dose Computed Tomography

Effective February 10, 2022, the Centers for Medicare & Medicaid Services (CMS) has expanded eligibility for people with Medicare to qualify for lung cancer screening with Low Dose Computed Tomography (LDCT) by lowering the starting age for screening from 55 to 50 years, and also by reducing the tobacco smoking history from at least 30 packs per year to at least 20 packs per year.

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Medicare
Medicaid
  
Provider Alerts - Pharmacy Resources & Formularies - Coronavirus (COVID-19) - Provider Resources - 2023
Pharmacy Billing Guidance for COVID-19 Vaccine Under Healthfirst’s Medicaid Managed Care Plan (MMC) and Personal Wellness Plan

During the declared State of New York disaster emergency, pharmacies may bill for COVID-19 vaccines that have been authorized by the FDA under Emergency Use Authorization (EUA) under Healthfirst’s Medicaid Managed Care Plan (MMC) and Personal Wellness Plan (PWP). View PDF for billing instructions.

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Personal Wellness Plan
  
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