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Showing 169-180 of 647
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Respiratory Failure, 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 Respiratory Failure.

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CMS-HCC_V28 Model Updates
Clinical Documentation Improvement
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-093v1 Obstetrical Ultrasound Procedures

Healthfirst has implemented the following reimbursement policy regarding the billing of CPT 76817 (Ultrasound, pregnant uterus, real time with image documentation, transvaginal) in conjunction with CPT 76801-76812 (Ultrasound, pregnant uterus, real time with image documentation, transabdominal)

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Reimbursement Policy
  
Provider Alerts - Coronavirus (COVID-19) - Practice Guidelines and Tips - 2023
Medicaid Members Under Age 19 are Eligible for the Vaccines for Children Program

Children under age 19 can receive the COVID‑19 vaccine at Vaccines for Children (VFC)‑enrolled providers, including their practitioner’s office, public health clinics, most county health departments, and any Medicaid‑ or VFC‑enrolled pharmacy.

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Medicaid
  
Education Events & Patient Care Resources - Quality Program Resources - Plans & Benefits - Provider Resources - 2024
2024 Special Needs Plan (SNP) Model of Care (MOC) Provider Training

This presentation will help educate providers, delegated vendors, and appropriate staff on the Healthfirst Special Needs Plan (SNP) Model of Care (MOC), the goal of which is to enhance member health outcomes through the use of an integrated care delivery system.

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Special Needs Plan
  
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 - 2024
Reimbursement Policy: PO-RE-091 Trigger Point Injections

Healthfirst aims to ensure that its reimbursement policy for trigger point injections aligns with state and national industry standards. This policy outlines the limitations and guidelines for the reimbursement of trigger point injections provided to Healthfirst members.

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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-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
  
Provider Alerts - Provider Resources - 2022
Healthfirst Connection Plan (HMO D-SNP) Announcement

Starting Jan. 1, 2024, Healthfirst will begin covering members in Healthfirst Connection Plan (HMO D-SNP), our newest Medicare Advantage Dual-Eligible Special Needs Plan. Read the Provider Alert for more details...

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Connection Plan
  
Provider Alerts - Compliance, Regulatory & Policies - Practice Guidelines and Tips - 2024
New State Requirements for Provider Compliance Programs

New York State has made changes to provider requirements for starting and maintaining compliance programs.

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Quality and Compliance
  
Claims & Billing - Form - 2024
Prior Authorization Request - Physical, Occupational, and Speech Therapies

Effective Jan. 1, 2024, Healthfirst has resumed responsibility for management of prior authorization (PA) requests for Physical, Occupational, and Speech Therapies. You may now submit PA requests for these services to Healthfirst for dates of service on or after Jan. 1, 2024. Please download this PDF of the fax request form or visit the Healthfirst Provider Portal at hfproviderportal.org to submit your request using our Online Authorization tool.

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Prior Authorization
  
Claims & Billing - Form - 2024
Prior Authorization Request - Podiatry and Peripheral Vascular Disease

Effective Jan. 1, 2024, Healthfirst resumed responsibility for management of prior authorization (PA) requests for Podiatry and Peripheral Vascular Disease. Starting Jan. 1, 2024, you may submit PA requests for these services to Healthfirst for dates of service on or after Jan. 1, 2024, by using this fax form. To submit your request via our Online Authorization tool, visit our Healthfirst Provider Portal at hfproviderportal.org. To create an account, select "Create your account." You may also contact your Healthfirst account manager.

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Prior Authorization
  
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