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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
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2022
Promoting Health Equity - A Resource to Help Communities Address Social Determinants of Health

This workbook is for public health practitioners and partners interested in addressing social determinants of health in order to promote health and achieve health equity

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Social Determinants of Health
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2022
AAFP Guide to Social Needs Screening

For the medical community to have a significant and lasting impact on the health of their patients and communities, it must address the needs of patients outside the clinic walls. Effectively implementing programs to identify and attend to these social factors depends on the specific needs of the patient population, the ability of the practice to assess these needs, and the availability of community resources.

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Social Determinants of Health
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2022
CMS Health-Related Social Needs Screening Tool

The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) made the Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) Screening Tool to use in the AHC Model.

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Social Determinants of Health
  
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
  
Quality Program Resources - Education Events & Patient Care Resources - Patient Resource - 2022
Help Your Patients Fight the Flu

Helpful guidance from Healthfirst and the CDC for making a strong flu shot recommendation to help patients make an informed health decision.

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Seasonal Flu
  
Coding - Practice Guidelines and Tips - 2022
Documentation and Coding: Lung Cancer

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 lung cancer.

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Clinical Documentation Improvement
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2022
Healthfirst 2022 Fall Symposium (Panel 1 booklet)

(Panel 1 booklet) The theme for the Nov. 18, 2022, Healthfirst Fall Symposium is Perspectives on Racism, Disparities, and Health Equity: Advancing Solutions. Guest speakers will highlight forward-looking initiatives in addressing health inequities in the treatment and care of Healthfirst members, practices, and communities who have been adversely impacted by disparities in health and social determinants.

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2022
Healthfirst 2022 Fall Symposium (Panel 2 booklet)

(Panel 2 booklet) The theme for the Nov. 18, 2022, Healthfirst Fall Symposium is Perspectives on Racism, Disparities, and Health Equity: Advancing Solutions. Guest speakers will highlight forward-looking initiatives in addressing health inequities in the treatment and care of Healthfirst members, practices, and communities who have been adversely impacted by disparities in health and social determinants.

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Provider Events
  
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
  
Behavioral Health and Foster Care - Practice Guidelines and Tips - 2022
FAQ for Behavioral Health Benefits Carve-In to Medicaid Advantage Plus (MAP)

View for frequently asked questions to Behavioral Health providers regarding the transition of Behavioral Health services into MAP plans.

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Behavioral Health
  
Provider Alerts - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2022
Behavioral Health Benefits Carve-In to Medicaid Advantage Plus (MAP)

Effective January 1, 2023, New York State (NYS) is carving additional Behavioral Health (BH) services into the Medicaid Advantage Plus (MAP) plan. Healthfirst's MAP plan is called CompleteCare.

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Behavioral Health
  
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