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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Billing Guidance for Acupuncturists

Medicare covers acupuncture for chronic lower back pain. Plans must offer this benefit and can choose to offer a supplemental benefit in addition to the original Medicare-covered visits. Previously, most Healthfirst providers submitted claims for acupuncture visits using ICD-10 M54.5. However, this ICD was retired on October 1, 2021.

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Billing
  
Provider Alerts - Claims & Billing - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2022
Child HCBS Authorizations and Reminder of State Billing and Claiming Requirements

This notice is to remind Children’s Home and Community-Based Services (HCBS) providers of HCBS billing and claiming requirements, per the April 4, 2022, NYSDOH memo.

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Billing
  
Provider Alerts - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
New York State Medicaid Coverage Criteria for Pharmacists Providing COVID-19 Vaccine Counseling

The New York State Department of Health issued guidance that New York State Medicaid will reimburse COVID-19 vaccination counseling to Medicaid members/enrollees by pharmacists in order to encourage vaccination against COVID-19. The effective date of coverage is for dates of service on or after December 1, 2021.

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Medicaid
  
Provider Alerts - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
New York Medicaid COVID-19 Vaccine Claims Submission Reminder

This information is being provided to assist your pharmacy with the submission of COVID-19 vaccine administration claims. The content of this communication is for informational purposes only and is not intended as a substitute for the information provided in the COVID-19 Vaccine Administration Network Enrollment Form.

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

Healthfirst aims to ensure that our reimbursement policy standards are up to date and are compliant with state and national industry standards. Effective September 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 - 2022
Healthfirst Reimbursement Policy Update

Healthfirst aims to ensure that our reimbursement policy standards are compliant with state and national regulatory requirements and industry standard coding and reimbursement practices. This update describes our reimbursement policy for certain surgical pathology claims.

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Reimbursement
  
Provider Alerts - Coronavirus (COVID-19) - Practice Guidelines and Tips - 2022
NYSDOH Issues Advisory: Sotrovimab No Longer Authorized to Treat COVID-19 in Any U.S. Region – Pause in Distribution

The New York State Department of Health (NYSDOH) issued an Advisory on March 25, 2022, announcing a pause in the distribution of sotrovimab.

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COVID-19
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Optos Optomap Imaging: 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 and medical requirements for Optos Optomap imaging.

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
2022 Medicare Advantage Sequestration Reinstatement

Effective April 1, 2022, CMS has reinstituted sequestration reductions to claims payments for Medicare enrollees in accordance with The Protecting Medicare and American Farmers from Sequester Cuts Act.

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Billing
  
Provider Alerts - Pharmacy Resources & Formularies - Provider Resources - 2023
Vyondys 53, Exondys 51, Amondys 45 and Viltepso Criteria

This policy is to provide guidance on the coverage guidelines utilized to review the request for prior authorization for Vyondys 53™ (golodirsen), Exondys 51™ (eteplirsen), Amondys 45™ (casimersen) and Viltepso™ (viltolarsen). These coverage guidelines will be used to determine medical necessity.

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Prior Authorization
  
Provider Alerts - Claims & Billing - Pharmacy Resources & Formularies - Provider Resources - 2023
Reimbursement Update for SPRAVATO

This notice is to inform providers about reimbursement updates for billing or submitting claims for the SPRAVATO medication.

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Billing
  
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
  
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