Changes to the Healthfirst Connection Plan (HMO D-SNP) and Life Improvement Plans Beginning in 2025

What happens next?

Healthfirst members currently enrolled in the Healthfirst Connection Plan will be moved to Healthfirst’s Life Improvement Plan (LIP) effective January 1, 2025.

For our Integrated Benefits Dual (IB Dual) members, Healthfirst will pay both Medicare and Medicaid cost sharing. No changes will be made for existing LIP members.

How will payments be made for Connection Plan and existing Life Improvement Plan Members?

All claims must be submitted using the Healthfirst member’s ID. Services will be reimbursed as follows:

• Services that are covered under Medicare will be paid based on the Medicare fee schedule
• Members cost-sharing will be paid through Medicaid Fee-for-Service or the Member’s assigned Medicaid plan

How will payments be made for Life Improvement Plan and Integrated Benefits Dual Members?

All claims must be submitted using the Healthfirst member’s ID. Services that are covered under both Medicare and Medicaid will be paid based on the Medicare fee schedule where: 

• Medicare pays first (primary payer) 
• Medicare cost-sharing (deductibles, copays, or coinsurance) will be paid under the Medicaid plan in accordance with New York State regulatory requirements

How can providers submit claim corrections for LIP IB-Dual members?

All claim corrections must be submitted using the Healthfirst Member ID.

Claim corrections must reference the primary claim (Medicare) even if the service is covered by Medicaid. Claim corrections that reference the secondary claim (Medicaid) will be rejected with Code 732: Information submitted inconsistent with billing guidance.

Questions?

If you have any questions, please contact your Network Account Manager, or call Provider Services at 1-888-801-1660, Monday to Friday, 8:30am-5:30pm

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”).
Released 12/16/2024