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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective March 2025

Starting March 20, 2025, Healthfirst will add prior authorization requirements for selected medical services.

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Administration
Authorization
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2025
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective April 2025

Starting April 6, 2025, Healthfirst will add prior authorization requirements for selected medical services. These changes are part of Healthfirst’s ongoing responsibility to evaluate its medical policies compared to the latest scientific evidence and specialty society guidance.

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Administration
Authorization
  
Education Events & Patient Care Resources - Patient Resource - 2020
New York State Department of Health AIDS Institute Resource Directory
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Infectious Diseases
  
Documentation & Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Benign Carcinoid Tumors, 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 Benign Carcinoid Tumors.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Documentation & Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Cholangitis, 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 common types of Cholangitis.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Changes to the Healthfirst Connection Plan (HMO D-SNP) and Life Improvement Plans Beginning in 2025

Starting January 1, 2025, Providers will need to bill Medicaid Fee-for-Service or Member’s Medicaid Coverage for Healthfirst Connection Plan Members’ cost sharing.

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Medicaid
Medicare
Reimbursement
  
Documentation & Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Hepatitis C, 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 chronic Hepatitis C.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Provider Alerts - Practice Guidelines and Tips - 2024
Scheduling Configuration Changes for Linked and Mutual Visits

Starting January 1, 2025, Healthfirst is creating new service code configurations to accurately account for Linked and Mutual Visits.

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Administration
Authorization
Licensed Home Care Services Agencies
Medicaid
  
Documentation & Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Pneumonia, 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 pneumonia.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Changes to Claims Submissions for Prenatal and Postpartum Services

Providers using bundled or global procedure codes for billing perinatal services must submit non-payment category II CPT codes for members in Medicaid, Personal Wellness Plans, Medicaid Advantage Plans, and Connection Plans.

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Medicaid
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2024
Healthfirst 2024 Fall Provider Symposium (November 15, 2024)

The 2024 Fall Provider Symposium, Evolving Models of Care: Bridging the Gap Between Behavioral Health and Primary Care, will offer innovative solutions integrating primary and behavioral health care. The symposium will highlight pragmatic models to address the challenges and optimize the health and well-being of families and adults in pursuit of health equity for our communities.

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Provider Events
  
Documentation & Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Pressure Ulcer, 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 Pressure Ulcer.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
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