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Showing 181-192 of 648
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
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Lung 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 common types of lung cancer.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Acute Kidney 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 Acute Kidney Failure.

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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-90 ICD-10-CM Excludes1 Notes

Effective 04/01/2024, Healthfirst expects the ICD-10-CM Excludes1 Notes policy in accordance with the ICD-10-CM coding guidelines and the Medicare Claims Processing Manual governed by the Centers for Medicare and Medicaid Services (CMS) to be followed.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-087 General Principles of Lab Test Coverage

The purpose of this policy is to establish the standards and guidelines that Healthfirst follows when determining coverage of lab tests.

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Reimbursement Policy
  
Provider Alerts - Policy, Billing, or Coverage Update - 2024
Mobile Crisis and Crisis Residence Service Changes

To improve access to crisis care, New York State received federal approval to consolidate and align its Mobile Crisis and Crisis Residence services. These Crisis Intervention State Plan Amendment (SPA) changes will start March 1, 2024.

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Preventive Measures
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Mobile Crisis and Crisis Residence Services: Important Updates and FAQs

New York State received federal approval to consolidate and align its Mobile Crisis and Crisis Residence services effective March 1, 2024.

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Preventive Measures
  
Plans & Benefits - Practice Guidelines and Tips - 2024
Article 29-I Health Facility

Voluntary Foster Care Agencies (VFCA) Reference Guide

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Administration
  
Provider Alerts - General Update - 2024
Healthfirst Availity Clearinghouse Update

Review our Frequently Asked Questions (FAQ) resource dedicated to the Availity Clearinghouse release on March 1st, 2024. We recognize that navigating through new processes and procedures can pose challenges, which is why we've curated this comprehensive list of frequently asked questions to provide you with assistance.

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Availity
  
Provider Alerts - Policy, Billing, or Coverage Update - 2024
Expanded Spinal Muscular Atrophy (SMA) Carrier Screening

New York State (NYS) Medicaid has provided coverage for Spinal Muscular Atrophy (SMA) carrier screening since 2014. However, effective October 1, 2023, the coverage criteria for SMA carrier screening has been expanded to all NYS Medicaid members who are planning to become, or already are pregnant.

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Preventive Measures
  
Provider Alerts - Policy, Billing, or Coverage Update - 2024
Healthfirst CompleteCare and Senior Health Partners Changes to Non-Emergency Transportation Benefits

Healthfirst CompleteCare (HMO D-SNP) and Senior Health Partners (SHP) Changes to Non-Emergency Transportation Benefits, Effective March 1, 2024. Services now available through NYS Medical Answering Services (MAS).

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Healthfirst Plans
  
Compliance, Regulatory & Policies - Provider Resources - 2024
The End of the Public Health Emergency, Part 4

The federal Public Health Emergency (PHE) related to the COVID‑19 pandemic ended on May 11, 2023. In this resource, you will find the latest PHE policy and procedure updates that may affect Healthfirst participating providers.

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Administration
  
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