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Provider Alerts - Claims & Billing - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2022
Child HCBS Authorizations and Reminder of State Billing and Claiming Requirements

This notice is to remind Children’s Home and Community-Based Services (HCBS) providers of HCBS billing and claiming requirements, per the April 4, 2022, NYSDOH memo.

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Billing
  
Provider Alerts - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
New York State Medicaid Coverage Criteria for Pharmacists Providing COVID-19 Vaccine Counseling

The New York State Department of Health issued guidance that New York State Medicaid will reimburse COVID-19 vaccination counseling to Medicaid members/enrollees by pharmacists in order to encourage vaccination against COVID-19. The effective date of coverage is for dates of service on or after December 1, 2021.

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Medicaid
  
Provider Alerts - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
New York Medicaid COVID-19 Vaccine Claims Submission Reminder

This information is being provided to assist your pharmacy with the submission of COVID-19 vaccine administration claims. The content of this communication is for informational purposes only and is not intended as a substitute for the information provided in the COVID-19 Vaccine Administration Network Enrollment Form.

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Medicaid
  
Provider Alerts - Coronavirus (COVID-19) - Practice Guidelines and Tips - 2022
NYSDOH Issues Advisory: Sotrovimab No Longer Authorized to Treat COVID-19 in Any U.S. Region – Pause in Distribution

The New York State Department of Health (NYSDOH) issued an Advisory on March 25, 2022, announcing a pause in the distribution of sotrovimab.

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COVID-19
  
Claims & Billing - Telehealth - Practice Guidelines and Tips - 2022
Guidance for ADHC Telehealth and In-Person Services

Healthfirst offers guidance to Adult Day Health Care (ADHC) providers to successfully obtain authorizations and reimbursement for the following services: - Telehealth Services - In-Person Services Upon Reopening

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Reimbursement
  
Provider Alerts - Coding - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Coding Instructions for Co-Surgeons and Team Surgeons

Healthfirst follows the Centers for Medicare & Medicaid Services (CMS) guidance for the use of co-surgeon (-62) and team surgeon (-66) modifiers with claim submissions.

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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 - 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
  
Coding - Practice Guidelines and Tips - 2022
Documentation and Coding: Alcohol Disorders

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for alcohol disorders.

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Clinical Documentation Improvement
  
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
  
Coding - Practice Guidelines and Tips - 2022
Documentation and Coding: Human Immunodeficiency Virus (HIV/AIDS)

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for common types of HIV/AIDS.

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Clinical Documentation Improvement
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2022
Healthfirst 2022 Spring Provider Symposium (video link and program)

Healthfirst’s semi-annual Provider Symposium features the innovative work of practices, health care organizations and industry leaders who care for and serve our members. Watch the Symposium replay at youtube.com/watch?v=P8YTAzYn6hY This Symposium offered a unique opportunity for experts from health care delivery, public health, and the community to share initiatives in the health delivery system for vulnerable patients who are receiving Cancer care across New York. Our speakers highlighted forward-looking initiatives in the treatment of Healthfirst members, practices, and communities affected by difference Cancers through innovative approaches. 

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Provider Events
  
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