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Provider Alerts - Quality Program Resources - Practice Guidelines and Tips - 2022
Redesigned Healthfirst Quality App

The redesigned Quality App is here! The improved tool helps you quickly identify areas of opportunity in the Healthfirst Quality Incentive Program (HQIP) and offers more insight into your performance trends.

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HQIP
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
0996 22 Auth for Vision Svcs Provider Alert v7 FINAL

Effective August 1, 2022, Healthfirst no longer requires authorization for the selected vision services listed in this Provider Alert.

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Authorization
  
Provider Alerts - Patient Care Resources - Practice Guidelines and Tips - 2022
Continuous Glucose Monitors for Diabetes Management

Healthfirst aims to enhance A1c control management, improve treatment outcomes, and prevent disease progression. We achieve these goals by first identifying Healthfirst plan members with Type 2 diabetes who are potentially eligible for a Continuous Glucose Monitor (CGM), after which we coordinate their care with providers to prevent future complications.

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HF Cares
  
Provider Alerts - Claims & Billing - Pharmacy Resources & Formularies - Provider Resources - 2023
New Physician Dispenser Policy

After September 1, 2022, Medicaid pharmacy claims submitted from a physician dispenser will be rejected by Healthfirst’s pharmacy benefit manager, CVS Caremark

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Billing
  
Provider Alerts - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2022
2022 Seasonal Influenza Vaccine Codes

These CPT influenza vaccine codes reflect updates to the recommendations on the use of seasonal influenza vaccines in the United States from the Advisory Committee on Immunization Practices (ACIP).

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Vaccine Codes
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
1448 22 BH PROS Auth Changes Provider Alert v2 Final WR

Effective Nov. 21, 2022, Healthfirst, in accordance with the State of New York, will no longer require prior authorization for Personalized Recovery Oriented Services (PROS).

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Medicaid Managed Care
  
Provider Alerts - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2022
Behavioral Health Benefits Carve-In to Medicaid Advantage Plus (MAP)

Effective January 1, 2023, New York State (NYS) is carving additional Behavioral Health (BH) services into the Medicaid Advantage Plus (MAP) plan. Healthfirst's MAP plan is called CompleteCare.

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Behavioral Health
  
Provider Alerts - Patient Care Resources - Policy, Billing, or Coverage Update - 2022
1560 22 Provider Alert Monkeypox Vaccine Coverage v5 FINAL wr

Healthfirst began covering the administration of the monkeypox vaccine on July 26, 2022. Learn more about two no-cost vaccines provided by The Centers for Disease Control and Prevention (CDC) and licensed by the U.S. Food and Drug Administration (FDA).

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Monkeypox
  
Provider Alerts - Policy, Billing, or Coverage Update - 2022
1713 22 Provider Alert Pharmacy Exceptions Guidance v3 Final WR

Details of the two exceptions to the New York State (NYS) Medicaid program's provider enrollment requirements allowed under the Medicaid Provider Enrollment Compendium (MPEC).

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Provider Enrollment
  
Provider Alerts - Practice Guidelines and Tips - 2023
1167 22 Provider Alert NPPES Updates FINA Lwr

Healthfirst would like to remind you to review your National Provider Identifier (NPI) data in the National Plan & Provider Enumeration System (NPPES) as soon as possible to ensure that the provider data displayed is accurate. Providers are legally required to keep their NPPES data current. The Centers for Medicare & Medicaid Services (CMS) also encourages Medicare Advantage Organizations to use NPPES as a resource for our online provider directories. By using NPPES, we may be able to change how often we contact you to validate directory information and provide more reliable information to Medicare beneficiaries

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Documentation
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Changes to Authorization Guidelines for Selected Services

Effective November 1, 2022, Healthfirst will make changes to its authorization guidelines for selected services. The service codes that newly require a prior authorization include pathology and laboratory services and non-oral and injectable chemotherapy drugs.

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Prior Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2023
1511 22 MA MOOP Calculation Provider Alert v5 FINAL wr

Effective 1/1/2023, the maximum out-of-pocket (MOOP) limit for a Medicare Advantage (MA) plan (after which the plan pays 100% of MA costs) will be calculated based on the accrual of all Medicare-covered cost sharing, not the supplemental benefits, in the plan benefit.

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Documentation
  
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