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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Enhancing Claims Processing Accuracy with ClaimsXten

ClaimsXten (CXT) is an industry-leading claims editing software that adjudicates claims more efficiently and aligns with Healthfirst standards. Review the provider alert for more information on CXT, including updated frequently asked questions.

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Administration
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2024
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective Jan. 1, 2025

Starting Jan. 1, 2025, Healthfirst will change its authorization guidelines for select CPT and HCPCS codes. See the Provider Alert for a list of codes that will now require prior authorization.

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Administration
Authorization
  
Behavioral Health and Foster Care - Practice Guidelines and Tips - 2024
Foster Care Provider Education Letter

This letter outlines key guidance providers should be mindful of when delivering care to Medicaid enrolled children/youth in direct placement foster care and in the care of Voluntary Foster Care Agencies.

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Medicaid
  
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
Video
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-111 Lactation Services

Healthfirst has expanded lactation services coverage under those plans to include reimbursement eligibility for providers certified by nationally recognized accrediting agencies.

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Reimbursement Policy
  
Coding - Video - 2024
Video - Documentation and Coding of Cerebral Infarction

This short video offers guidance on proper clinical documentation and coding of cerebral infarction.

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Clinical Documentation Improvement
Video
  
Coding - Video - 2024
Video - Documentation and Coding of Prostate Cancer

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

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Clinical Documentation Improvement
Video
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Thyroid Cancer, 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 Thyroid Cancer.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-116 CPT Category III Codes

This policy applies to all healthcare providers submitting claims to Healthfirst for services that include CPT Category III codes.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-109 Vaccine Administration

Healthfirst acknowledges the importance of vaccination in promoting public health and aims to align its reimbursement policies with the latest Centers for Disease Control (CDC) recommendations for coding, cost-sharing, and pricing of vaccine administration services. These guidelines outline the reimbursement policy for vaccination services provided by healthcare providers within the Healthfirst network.

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Reimbursement Policy
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2020
Vaccine Schedules For You and Your Family

Stay up to date on getting recommended vaccines for you and your family.

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Vaccines
  
Provider Alerts - Practice Guidelines and Tips - 2024
Healthfirst’s Eligibility Search Tool Will Fully Transition to Availity

Starting October 1, 2024, Healthfirst’s Eligibility Search tool will be accessible only through Availity Essentials. Access to the Eligibility Search tool via HFproviderportal.org will end after September 30, 2024, and providers will be redirected to log into Availity Essentials.

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Administration
  
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