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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
  
Provider Alerts - Practice Guidelines and Tips - 2024
Availity Essentials™: Healthfirst’s New Provider Portal Launching July 2024

We are excited to announce that Healthfirst is transitioning to Availity Essentials as our new secure provider portal platform. This transition represents our commitment to continually improving our services and enhancing your overall experience with Healthfirst.

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Administration
  
Provider Alerts - Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Provider-Identified Overpayments

If a provider determines that Healthfirst has overpaid a claim, the provider shall, within 60 days of discovery, send a refund check made out to Healthfirst PHSP, Inc. in the amount of the overpayment. View the provider alert for details.

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Reimbursement
  
Provider Alerts - Provider Resources - 2023
Healthfirst Provider Toolkit: Patient Recertification - Patient Renewal Email

This email text explains recertification to your Healthfirst patients. You can copy and paste it into your practice’s patient emails.

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Recertification