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Provider Alerts - Behavioral Health and Foster Care - Patient Care Resources - Provider Resources - 2023
Children’s Home and Community-Based Services (HCBS) Frequently Asked Questions

Children's Home and Community-Based Services (HCBS) are provided in the community and help children and youth be successful at home, in school, and in other environments. HCBS are personal and flexible and are meant to meet the physical health, behavioral health, and/or developmental needs of each child/youth.

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Children & Family
  
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 - Policy, Billing, or Coverage Update - 2023
Change in Level of Service Determinations and Prior Authorizations for Assertive Community Treatment

Effective June 20, 2023, Healthfirst, in accordance with the State of New York, will no longer require Level of Service Determinations (LOSD) or prior authorization for Assertive Community Treatment (ACT)

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ACT
  
Provider Alerts - Pharmacy Resources & Formularies - Policy, Billing, or Coverage Update - 2023
NYRx Transition Fill Period Ending

Effective April 1, 2023, Medicaid members enrolled in Medicaid Managed Care (MMC) Plans, Health and Recovery Plans (HARP), and HIV-Special Needs Plans (SNPs) began receiving their pharmacy benefits through NYRx, the Medicaid Pharmacy program.

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Pharmacy
  
Provider Alerts - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2023
BH | Prior Authorization Guidelines

Review this provider alert for BH prior authorization guidelines that apply to in-network providers only.

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Prior Authorization
  
Provider Alerts - Behavioral Health and Foster Care - Plans & Benefits - Practice Guidelines and Tips - 2023
FAQ: Health and Recovery Plans (HARP) and Healthfirst’s Personal Wellness Plan (PWP)

See answers to frequently asked questions about Health and Recovery Plans and Healthfirst’s Personal Wellness Plan.

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HARP Health And Recovery Plan
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2023
New Prior Authorization Guidelines for Select Services

Effective Nov. 1, 2023, Healthfirst will change its authorization guidelines for select services due to newly created codes on the CMS code list. As of that date, the services requiring prior authorization will include spinal surgery services managed through OrthoNet™, as well as radiation therapy and laboratory services managed through eviCore.

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Prior Authorization
  
Provider Alerts - Coding - Practice Guidelines and Tips - 2023
Invalid ICD-10-CM Diagnosis Codes are Expiring

Healthfirst is updating our ICD-10-CM diagnosis code set to meet the specificity requirements established by the Centers for Medicare & Medicaid Services (CMS).

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Coding
  
Provider Alerts - Claims & Billing - Coronavirus (COVID-19) - Telehealth - Policy, Billing, or Coverage Update - 2022
Coronavirus: Telehealth Policies FAQ

Did you know that providers need to be approved by Healthfirst to continue qualifying for reimbursement of telehealth services? Access our FAQs to learn more.

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COVID-19
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
Drug Testing Policy

Healthfirst aims to ensure that our policy standards are up to date and are compliant with state and national industry standards. Effective February 1, 2021, Healthfirst has limited the reimbursement of drug testing as outlined in this document.

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Reimbursement
  
Provider Alerts - Behavioral Health and Foster Care - Practice Guidelines and Tips - 2023
Cultural Competency Training for Participating Providers

New York State Department of Health requires providers and their office staff who have regular and substantial contact with Healthfirst members certify annually the completion of Cultural Competency Training.

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Behavioral Health
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Medicare Coverage Billing Guidance for Intensive Outpatient Programs

As of Jan. 1, 2024, Medicare now covers Intensive Outpatient Services. Learn more about the program and billing requirements here.

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Behavioral Health and Mental Health
Reimbursement
Medicare
  
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