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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2023
Healthfirst to Manage Some Outpatient Authorization Requests Formerly Handled by OrthoNet

Effective Jan. 1, 2024, Healthfirst will resume responsibility for management of prior authorization (PA) requests for all Physical, Occupational, and Speech Therapies; Podiatry Services, and Vascular Surgery. This Provider Alert will help you understand how this change might affect you...

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Prior Authorization
  
Provider Alerts - Behavioral Health and Foster Care - Practice Guidelines and Tips - 2023
Behavioral Health Utilization Review Implementation

In response to a requirement by the New York State Office of Mental Health (OMH), Healthfirst has implemented a new, trigger-based approach to utilization review (UR) for certain acute mental health services (MH) for all of our health plans, except for Medicare Advantage plans.

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Behavioral Health
  
Provider Alerts - Pharmacy Resources & Formularies - Practice Guidelines and Tips - 2023
Obtaining Physician-Administered Drugs through a Specialty Pharmacy

As a Healthfirst provider, you can get Physician-Administered Drugs (PADs) delivered to your office at no cost through White Bagging when the medication is obtained from a Healthfirst in-network specialty pharmacy provider.

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Pharmacy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2023
Medical Nutrition Therapy Added to the Article 29-I VFCA Health Facilities

In accordance with the approved Medicaid State Plan Amendment: Medical Nutrition Therapy (MNT) has been added to the Article 29-I VFCA Health Facilities (29-I) Other Limited Health Related Services (OLHRS) Fee Schedule. View for more details.

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Billing
  
Provider Alerts - Claims & Billing - Provider Resources - 2023
Pharmacist-Administered Human Papillomavirus (HPV) Vaccine Now Available to Healthfirst Patients Aged 18+

New York law has expanded the types of immunizations licensed pharmacists can administer to patients 18 years or older, including the HPV vaccine.

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Vaccines
  
Provider Alerts - Coronavirus (COVID-19) - Practice Guidelines and Tips - 2023
Medicaid Members Under Age 19 are Eligible for the Vaccines for Children Program

Children under age 19 can receive the COVID‑19 vaccine at Vaccines for Children (VFC)‑enrolled providers, including their practitioner’s office, public health clinics, most county health departments, and any Medicaid‑ or VFC‑enrolled pharmacy.

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Medicaid
  
Provider Alerts - Policy, Billing, or Coverage Update - 2023
Reminder: EyeMed Relationship Begins Jan. 1, 2024

Effective Jan. 1, 2024, EyeMed will be responsible for prior authorization for surgical and therapeutic vision services as well as network management, related member and provider service calls, prior authorization, and claims payment for routine vision and medical optometry services for Healthfirst members. Davis Vision and Superior Vision will no longer be contracted with Healthfirst as of that date.

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Vision Services
  
Provider Alerts - Practice Guidelines and Tips - 2023
Provider Credentialing

This Provider Alert announces Healthfirst's new partnership with Andros, an industry leading, NCQA-Certified, CVO (Credentials Verification Organization), effective October 1, 2023.

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Credentialing
  
Provider Alerts - Policy, Billing, or Coverage Update - 2020
Authorization Requirement Update for Echocardiography Services
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Authorization
  
Provider Alerts - Policy, Billing, or Coverage Update - 2020
Recovery Coordination Agency (RCA
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HARP Health And Recovery Plan
  
Provider Alerts - Practice Guidelines and Tips - 2022
Proper Use of Modifier "-25"
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Reimbursement
  
Provider Alerts - Policy, Billing, or Coverage Update - 2020
Removal of Impacted Cerumen
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Reimbursement
  
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