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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Reimbursement Update for eConsults

The New York State Medicaid fee-for-service program will reimburse for electronic consultations (eConsults) for select plans.

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Administration
Reimbursement
Medicaid
  
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
Prior Authorization Request Enhancements for Select Outpatient Service Authorizations

Select Outpatient Services may be eligible for immediate prior authorization approval. Learn how to obtain faster authorizations through our Online Authorization Request tool.

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Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
New York State Medicaid Guidance for Billing Respiratory Syncytial Virus (RSV) Vaccines

As of Oct. 1, 2023, New York State (NYS) Medicaid began reimbursing NYS Medicaid-enrolled providers for administration or dispensing of Respiratory Syncytial Virus (RSV) vaccines for adults and for the administration of nirsevimab for infants.

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Billing
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Major Depressive Disorder, 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 Major Depressive Disorder.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Seizure Disorders and Convulsions, 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 common types of Seizure Disorders and Convulsions.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Claims & Billing - Provider Resources - 2024
Healthfirst Clinical Guidelines 2024

Healthfirst wishes to be transparent in the clinical guidelines we use when reviewing authorizations. We are pleased to share a new feature on our Provider Portal: Clinical Guidelines. This tool outlines the clinical criteria Healthfirst uses to support member care decisions. Please note: Guidelines for authorizations managed by our delegated vendors can be found by visiting the respective delegated vendor websites. Please follow the steps outlined in this document to use this helpful new feature.

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Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Provider Fee Schedule Corrections

Healthfirst is conducting a routine review and alignment of provider contracts with our system configuration.

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Administration
Reimbursement
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-004 Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing

Parathyroid hormone (PTH), along with calcitriol and fibroblast growth factor 23 (FGF23), regulate calcium and phosphate homeostasis.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-007 Intracellular Micronutrient Analysis

Micronutrients are dietary components, often referred to as vitamins and minerals, which although only required by the body in small amounts, are vital to development, disease prevention, and wellbeing.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-011 Lyme Disease Testing

Lyme disease is a common multisystem inflammatory disease caused by spirochetes of the family Borreliaceae transmitted through the bite of an infected tick of the genus Ixodes (Barbour, 2022).

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-018 Diagnosis of Vaginitis

Vaginitis is defined as inflammation of the vagina with symptoms of discharge, itching, and discomfort often due to a disruption of the vaginal microflora.

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Reimbursement Policy
  
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