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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2023
Expansion of Lactation Service Coverage

Consistent with new requirements established for NYS Medicaid Managed Care (MMC) plans (including mainstream MMC plans, Human Immunodeficiency Virus (HIV) Special Needs Plans (HIV-SNPs), and Health and Recovery Plans (HARPs)), Healthfirst has expanded lactation services coverage under those plans to include reimbursement eligibility for providers certified by nationally recognized accrediting agencies.

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Medicaid Managed Care
  
Coding - Policy, Billing, or Coverage Update - 2024
Medicare Physician and Practitioner Providers - Medical Record Request for Calendar Year 2022 (CY22) Part C Improper Payment Measure (Part C IPM)

This request is based on diagnosis data submitted to the Centers for Medicare & Medicaid Services (CMS) as a result of services you provided to MA beneficiaries during calendar year 2021 (CY21). The purpose of this request is to validate diagnoses that were sent to CMS to determine health status-adjusted payments under risk adjustment.

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Risk Adjustment Data Validation Audit
  
Coding - Policy, Billing, or Coverage Update - 2024
Medicare Hospitals - Medical Record Request for Calendar Year 2022 (CY22) Part C Improper Payment Measure (Part C IPM)

This request is based on diagnosis data submitted to the Centers for Medicare & Medicaid Services (CMS) as a result of services you provided to MA beneficiaries during calendar year 2021 (CY21). The purpose of this request is to validate diagnoses that were sent to CMS to determine health status-adjusted payments under risk adjustment.

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Risk Adjustment Data Validation Audit
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Sepsis, 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 sepsis.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Severe Sepsis

This tip sheet will offer guidance on how to submit a diagnosis code with greater specificity for coding Severe Sepsis. Two codes, at a minimum, are needed to report severe sepsis without septic shock. Chapter‑specific guidelines state, “First code for the underlying systemic infection, followed by a code R65.20, Severe sepsis. If the causal organism is not documented, assign code A41.9, Sepsis, unspecified organism, for the infection. Additional code(s) for the associated acute organ dysfunction are also required.”

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Clinical Documentation Improvement
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Septic Shock

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 septic shock. Septic shock generally refers to circulatory failure associated with severe sepsis and therefore represents a type of acute organ dysfunction.

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Clinical Documentation Improvement
  
Provider Alerts - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2023
Billing Guidance for COVID-19 Vaccine Under Healthfirst’s Plans

Healthfirst continues to monitor COVID-19 vaccine updates from the state and federal government and from other healthcare agencies. This guidance provides billing information on COVID-19 vaccines. (Updated June 2023)

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Billing
  
Plans & Benefits - Practice Guidelines and Tips - 2023
2023 Healthfirst Plans at a Glance

Healthfirst has health plans for all New Yorkers.

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At a Glance
  
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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Preventive Measures
  
Plans & Benefits - Policy, Billing, or Coverage Update - 2023
Introducing Healthfirst Signature (PPO)

Signature (PPO) is a NEW Healthfirst Medicare Advantage plan for those looking for hospital, medical, and prescription drug coverage all in one.

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Signature (PPO)
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Asthma

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 Asthma.

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Clinical Documentation Improvement
  
Plans & Benefits - Practice Guidelines and Tips - 2023
Provider Resource Guide

This resource provides relevant information to assist you in working with Healthfirst and our members.

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At a Glance
  
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