Clinical Document Submission for Healthfirst Personal Wellness Plan

The Health and Recovery Plans (HARP) program is a Medicaid Managed Care plan created by New York State to better assist adults diagnosed with serious mental illness (SMI) and substance use disorders (SUDs) in their recovery. Personal Wellness Plan (PWP) is the plan name of Healthfirst’s HARP offering.

Below you will find information on frequently asked questions related to the submission of clinical documents by Behavioral Health providers for HARP/PWP members.

Frequently Asked Questions (FAQs)

1. Can I submit a verbal Level of Service Request (LOSR)?

• Yes. Verbal LOSRs are accepted via Provider Services at 1-888-801-1660 Monday to Friday, 8:30am–5pm.

2. How do I submit the LOSR or Plan of Care (POC) document for Adult Behavioral Health Home and Community Based Services (BH HCBS)?

• The documents can be submitted through Healthfirst's Online Authorization Tool located in Availity Essentials.

3. Can I submit the LOSR/POC via secure email?

• No. Healthfirst doesn’t accept clinical documents via email. If the LOSR/POC is submitted via email, it won’t be processed and will require resubmission via the proper channel stated above.

4. How can I confirm Healthfirst has received the LOSR/POC I submitted?

• Contact Provider Services at 1-888-801-1660 Monday to Friday, 8:30am–5pm.

5. How will I be notified of LOSR/POC approval?

• A Healthfirst Care Manager will call the Care Manager listed on the LOSR/POC to provide verbal approval and recommend providers for the approved Adult BH HCBS. A Level of Service Determination (LOSD) letter will be faxed the same day to the fax number listed on the LOSR/POC. If the fax number is unavailable after three attempts, the letter will be mailed via USPS.

6. How long does it take to receive the LOSD approval letter?

• Healthfirst issues LOSD approval 3–14 business days upon receipt of the LOSR.

7. Can the LOSD approval letter be sent via email?

• No. Healthfirst doesn’t send approval letters via email.

8. Which documents can be submitted via fax?

• LOSR, POC, and Adult BH HCBS authorization documents can be sent via the BH fax, line at 1-646-313-4612. However, for faster submission, providers are encouraged to submit using the online authorization tool’s “supporting documentation” feature through Availity Essentials.

9. What should I do if the Adult BH HCBS providers are not accepting referrals, are no longer providing Adult BH HCBS, or are not responding to my outreach?

• Contact the Healthfirst Behavioral Health Care Manager who provided you with the Adult BH HCBS referrals to request additional referrals or to clarify status of an Adult BH HCBS provider. You can also consult the Healthfirst Provider Directory: healthfirst.org/find-a-doctor

10.How often do I need to resubmit the POC and eligibility assessment?

• Both must be conducted annually. The eligibility assessment must also be signed and locked in the Uniform Assessment System (UAS).

11.Can an expired Eligibility Assessment be used to approve POC?

• No, LOSR/POC documents will not be approved if the Eligibility Assessment has expired. Agencies can generate an “aggregate report” in UAS to determine members due for reassessment.

Questions?

For Policy and Adult BH HCBS Workflow questions please contact the following individuals:

• Neela Mangal, Sr. Manager, Behavioral Health Care Management, at 1-347-324-9376 or nmangal@healthfirst.org
• Jacqueline Leacock, Manager, Behavioral Health, at 1-332-877- 9122 or jleacock@healthfirst.org

For all other questions please contact your Network Account Manager, or call Provider Services at 1-888-801-1660, Monday to Friday, 8:30am-5:30pm.