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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-102 Taxonomy

A taxonomy code is a unique 10-character alphanumeric code that signifies a provider’s classification and area of specialization.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-098 Monkeypox Vaccine Coverage

This policy outlines the reimbursement guidelines for coverage of the monkeypox vaccination and administration.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-096 New Physician Dispenser

Effective September 1, 2022, Medicaid pharmacy claims submitted from a physician dispenser will be rejected by Healthfirst’s pharmacy benefit manager, CVS Caremark.

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Reimbursement Policy
  
Provider Alerts - General Update - 2024
Healthfirst Availity Clearinghouse Update

Review our Frequently Asked Questions (FAQ) resource dedicated to the Availity Clearinghouse release on March 1st, 2024. We recognize that navigating through new processes and procedures can pose challenges, which is why we've curated this comprehensive list of frequently asked questions to provide you with assistance.

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Availity
  
Coding - Video - 2024
Video - Documentation and Coding of Breast Cancer

This 5-minute video offers guidance on proper clinical documentation and coding of breast cancer.

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Clinical Documentation Improvement
  
Patient Care Resources - Patient Resource - 2020
YMCA

New York City's YMCA

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Weight Management
  
Plans & Benefits - Practice Guidelines and Tips - 2024
Article 29-I Health Facility

Voluntary Foster Care Agencies (VFCA) Reference Guide

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Administration
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Aspiration Pneumonia, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model Updates, on services submitted to Healthfirst—specifically for types of Aspiration Pneumonia.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Updates on Coverage of Community Health Worker Services

Effective Oct. 1, 2023, Healthfirst will reimburse Community Health Worker (CHW) services for pregnant and postpartum people as a preventive medical service when billed under a Medicaid-enrolled supervising licensed provider. See the provider alert for additional updates.

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Billing
Reimbursement
  
Plans & Benefits - Provider Resources - 2024
The Essential Plan at a Glance

Federally subsidized plans for individuals who are ineligible for Medicaid due to income or immigration status.

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Healthfirst Plans
  
Provider Alerts - Provider Resources - 2024
Announcing Essential Plan 200–250

Healthfirst is excited to announce our newest benefit plan, Essential Plan 200–250, launching on April 1, 2024. This new plan is part of New York State’s continued efforts to improve health insurance affordability and accessibility. Healthfirst is proud to be the only 5-star-rated Essential Plan in New York State.

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Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
New Effective Date for Acupuncture, Occupational Therapy, Physical Therapy, and Speech Therapy Standard Fee Schedule Rates

The effective date for these changes has been delayed from April 1, 2024, to June 1, 2024.

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Reimbursement
  
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