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Provider Alerts - Policy, Billing, or Coverage Update - 2023
Reminder: EyeMed Relationship Begins Jan. 1, 2024

Effective Jan. 1, 2024, EyeMed will be responsible for prior authorization for surgical and therapeutic vision services as well as network management, related member and provider service calls, prior authorization, and claims payment for routine vision and medical optometry services for Healthfirst members. Davis Vision and Superior Vision will no longer be contracted with Healthfirst as of that date.

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Vision Services
  
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
  
Claims & Billing - Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2021
Reimbursement Policy: Anesthesia Start and Stop Times

Healthfirst requires that providers include the start time, stop time, and duration of anesthesia in the note segment of the 5010 claim form.

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Reimbursement
  
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
  
Provider Alerts - Practice Guidelines and Tips - 2023
Provider Credentialing

This Provider Alert announces Healthfirst's new partnership with Andros, an industry leading, NCQA-Certified, CVO (Credentials Verification Organization), effective October 1, 2023.

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Credentialing
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-092v1 Ultrasound Diagnostic Procedures

Healthfirst will no longer provide reimbursement for CPT 76856 (Ultrasound, pelvic [non-obstetric], real time with image documentation; complete) or CPT 76857 Ultrasound, pelvic [non-obstetric], real time with image documentation; limited or follow-up) when billed with CPT 76830 (Transvaginal ultrasound) unless extenuating circumstances are present to validate the necessity of both studies.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-089v1 Radiopharmaceuticals

Healthfirst has updated its reimbursement policy for radiopharmaceuticals commonly used for myocardial perfusion imaging studies.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-088v1 National Drug Code Billing Requirements

This policy describes the National Drug Code (NDC) information that is required on professional and outpatient facility drug claims that are reported for reimbursement.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-086v1 Place of Service

Healthfirst will reimburse services when reported with an appropriate Place of Service (POS).

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Reimbursement Policy
  
Provider Resources - 2023
Healthfirst Provider Toolkit: Patient Recertification - Waiting Room Material in Spanish

A helpful flyer that explains recertification to your Healthfirst patients. Print copies and leave them in the waiting room to help your Healthfirst patients navigate the renewal process.

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Recertification
  
Provider Resources - 2023
Healthfirst Provider Toolkit: Patient Recertification - Waiting Room Material in English

A helpful flyer that explains recertification to your Healthfirst patients. Print copies and leave them in the waiting room to help your Healthfirst patients navigate the renewal process.

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Recertification
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Pulmonary Embolism, 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 Pulmonary Embolism.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
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