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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Optos Optomap Imaging: Coding, Billing, and Medical Requirements

To ensure appropriate payments and maintain billing efficiencies, Healthfirst is committed to informing providers of specific requirements for the usage of any medical device. This alert provides guidance on Healthfirst coding and medical requirements for Optos Optomap imaging.

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
2022 Medicare Advantage Sequestration Reinstatement

Effective April 1, 2022, CMS has reinstituted sequestration reductions to claims payments for Medicare enrollees in accordance with The Protecting Medicare and American Farmers from Sequester Cuts Act.

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Billing
  
Provider Alerts - Pharmacy Resources & Formularies - Provider Resources - 2023
Vyondys 53, Exondys 51, Amondys 45 and Viltepso Criteria

This policy is to provide guidance on the coverage guidelines utilized to review the request for prior authorization for Vyondys 53™ (golodirsen), Exondys 51™ (eteplirsen), Amondys 45™ (casimersen) and Viltepso™ (viltolarsen). These coverage guidelines will be used to determine medical necessity.

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Prior Authorization
  
Provider Alerts - Claims & Billing - Pharmacy Resources & Formularies - Provider Resources - 2023
Reimbursement Update for SPRAVATO

This notice is to inform providers about reimbursement updates for billing or submitting claims for the SPRAVATO medication.

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Billing
  
Provider Alerts - Quality Program Resources - Practice Guidelines and Tips - 2022
Redesigned Healthfirst Quality App

The redesigned Quality App is here! The improved tool helps you quickly identify areas of opportunity in the Healthfirst Quality Incentive Program (HQIP) and offers more insight into your performance trends.

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HQIP
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
0996 22 Auth for Vision Svcs Provider Alert v7 FINAL

Effective August 1, 2022, Healthfirst no longer requires authorization for the selected vision services listed in this Provider Alert.

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Authorization
  
Provider Alerts - Patient Care Resources - Practice Guidelines and Tips - 2022
Continuous Glucose Monitors for Diabetes Management

Healthfirst aims to enhance A1c control management, improve treatment outcomes, and prevent disease progression. We achieve these goals by first identifying Healthfirst plan members with Type 2 diabetes who are potentially eligible for a Continuous Glucose Monitor (CGM), after which we coordinate their care with providers to prevent future complications.

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HF Cares
  
Provider Alerts - Claims & Billing - Pharmacy Resources & Formularies - Provider Resources - 2023
New Physician Dispenser Policy

After 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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Billing
  
Provider Alerts - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2022
2022 Seasonal Influenza Vaccine Codes

These CPT influenza vaccine codes reflect updates to the recommendations on the use of seasonal influenza vaccines in the United States from the Advisory Committee on Immunization Practices (ACIP).

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Vaccine Codes
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Changes to Authorization Guidelines for Selected Services

Effective November 1, 2022, Healthfirst will make changes to its authorization guidelines for selected services. The service codes that newly require a prior authorization include pathology and laboratory services and non-oral and injectable chemotherapy drugs.

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Prior Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2023
Expansion of Lactation Service Coverage

Consistent with new requirements established for NYS Medicaid Managed Care (MMC) plans (including mainstream MMC plans, Human Immunodeficiency Virus (HIV) Special Needs Plans (HIV-SNPs), and Health and Recovery Plans (HARPs)), 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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Medicaid Managed Care
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
1448 22 BH PROS Auth Changes Provider Alert v2 Final WR

Effective Nov. 21, 2022, Healthfirst, in accordance with the State of New York, will no longer require prior authorization for Personalized Recovery Oriented Services (PROS).

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Medicaid Managed Care
  
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