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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-100 Surgical Pathology

Healthfirst has established a policy regarding the number of units payable for surgical pathology services.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-099 Oral Sleep Apnea Device Appliance

Healthcare Common Procedure Coding System (HCPCS) E0485 and E0486 describe oral appliances which are used for the treatment of Obstructive Sleep Apnea (OSA).

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2024
New Prior Authorization Guidelines for Select Services effective July 1, 2024

Effective July 1, 2024, Healthfirst will change its authorization guidelines for select services on the CMS code list. As of that date, the services requiring prior authorization will include laboratory services (managed through eviCore). See the Provider Alert for a list of codes that will now require prior authorization.

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Authorization
  
Provider Alerts - Provider Resources - 2024
Lymphedema Compression Treatment Items Now Covered by Medicare

A new benefit category has been established for Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for standard and custom-fitted compression garments and additional lymphedema compression treatment items that are primarily and customarily used to serve a medical purpose.

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Medicare
  
Pharmacy Resources & Formularies - Provider Resources - 2024
Prior Authorization Pharmacy Medical Benefit Grid

It is the policy of Healthfirst to require prior authorization for medical claims for all medications listed within this document. To learn more, including ways to submit prior authorization, access this resource.

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Authorization
  
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
  
Patient Care Resources - Patient Resource - 2020
New York State Recommended Childhood and Adolescent Immunization Schedule

New York State Recommended Childhood and Adolescent Immunization Schedule

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Vaccines
  
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
  
Provider Alerts - Practice Guidelines and Tips - 2024
Tips to Increase Colorectal Screenings

Remind patients to schedule a colorectal cancer exam starting at age 45. A screening can detect cancer early, when it’s easier to treat. Review these tips.

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Preventative Measures
  
Provider Alerts - Telehealth - Claims & Billing - Policy, Billing, or Coverage Update - 2023
Telehealth Place of Service Changes

With the ending of the Federal Public Health Emergency, Healthfirst will be aligning with New York State (NYS) and Centers for Medicare & Medicaid Services (CMS) guidance on Telehealth Place of Service (POS) billing and reimbursement.

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Reimbursement
Administration
  
Provider Alerts - Telehealth - Policy, Billing, or Coverage Update - 2021
Privileging of Providers to Offer Telehealth Services

Healthfirst has established a policy and application process to enable our network of contracted providers to offer telehealth services to our members to improve access to care and outcomes of care. The policy and application process detailed herein is applicable to all providers and vendors who wish to render telehealth services.

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Administration
  
Telehealth - Policy, Billing, or Coverage Update - 2021
Healthfirst Telehealth Designation Application

Telehealth Assessment Tool. Please reach out to your Healthfirst Network Account Manager for more information

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Administration