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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-085 Chest X-Rays for Lung Cancer Screening

This policy outlines the reimbursement guidelines for chest X-ray procedures performed for the sole purpose of lung cancer screening or assessing nicotine use/dependence.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-084 Radiological Chest Examination

Healthfirst will no longer reimburse for chest X-Ray procedures with service codes 71045 and 71046 unless there is a diagnosis of pertinent signs, symptoms, or diseases.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-083 General Ophthalmological Exams

This reimbursement policy outlines the guidelines for the reimbursement of comprehensive ophthalmological exams and intermediate ophthalmological exams for service codes 92012 and 92014.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

This policy outlines the reimbursement procedures for Vaccines for Children (VFC) at Healthfirst, ensuring compliance with New York State (NYS) Medicaid guidelines.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-075 Laboratory Procedures

To be considered for reimbursement, all outpatient laboratory claims should be submitted in accordance with: -AMA CPT and HCPCS coding and ICD-10 diagnosis coding guidelines -Other laboratory and pathology coding guidelines -All applicable regulatory guidelines

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-074 Remote Patient Monitoring and Remote Therapeutic Monitoring

The purpose of this policy is to outline the reimbursement guidelines for Remote Patient Monitoring (RPM) services and Remote Therapeutic Monitoring (RTM) services offered by Healthfirst.

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Reimbursement Policy
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Morbid Obesity

This video offers guidance on proper clinical documentation and coding of Morbid Obesity

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2025
Video - Documentation and Coding of Human Immunodeficiency Virus (HIV)

This video offers guidance on proper clinical documentation and coding of Human Immunodeficiency Virus (HIV)

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2025
Video - Documentation and Coding of Hepatitis C

This video offers guidance on proper clinical documentation and coding of Hepatitis C

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Chronic Obstructive Pulmonary Disease (COPD)

This video offers guidance on proper clinical documentation and coding of Chronic Obstructive Pulmonary Disease (COPD)

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Angina

This video offers guidance on proper clinical documentation and coding of Angina

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Clinical Documentation Improvement
Video
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2026
Interoperability and Prior Authorization Final Rule Requirements

Healthfirst is updating prior authorization and concurrent review decision timeframes to comply with the CMS Interoperability and Prior Authorization Final Rule. Effective January 1, 2026, standard authorization decisions for applicable Medicaid and Medicare lines of businesses.

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Medicaid
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