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Provider Alerts - Practice Guidelines and Tips - 2024
2024 Medicare CAHPS Season Starts in March

Between March and June, a random sample of Healthfirst Medicare Plan members will receive the annual Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey. The CAHPS survey measures member experience with their health plan and providers, including experience with accessing care and care coordination. For participating providers, ensuring your patients’ satisfaction will help improve your performance in the Healthfirst Quality Incentive Program (HQIP).

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Medicare
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Neoplasm of the Meninges

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 Neoplasm of the Meninges.

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Clinical Documentation Improvement
  
Provider Alerts - Claims & Billing - Pharmacy Resources & Formularies - Plans & Benefits - Policy, Billing, or Coverage Update - 2023
Transition of the Pharmacy Benefit from Managed Care to Fee-for-Service

Effective April 1, 2023, Medicaid members enrolled in Medicaid Managed Care (MMC) Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) will receive their pharmacy benefits through the NYRx Pharmacy program, formerly known as the NYS Fee-for-Service (FFS) Pharmacy program.

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Pharmacy
  
Provider Alerts - Claims & Billing - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2023
Coverage Update: Monoclonal Antibody Therapies

As of December 1, 2022, bebtelovimab is not FDA-approved and will not be covered by Healthfirst. View details.

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COVID-19
  
Provider Alerts - Policy, Billing, or Coverage Update - 2023
Inflation Reduction Act Impacts Cost Sharing for Medicare Part B Drugs

Beginning April 1, 2023, cost sharing for Medicare Part B Drugs will be impacted in accordance with §11101 and §11407 of the Inflation Reduction Act (IRA, P.L. 117-169)*

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Quality and Compliance
  
Provider Alerts - Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Provider Alert: Medicaid FFS Enrollment Requirement for Providers

Healthfirst has reinstated the Medicaid Management Information System (MMIS) enrollment requirement.

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Medicaid
  
Provider Alerts - Plans & Benefits - Patient Resource - 2023
Provider Alert - 2023 FPL Expansion

Thanks to expanded eligibility, more Medicare beneficiaries will qualify for the Medicare Savings Program (MSP) in 2023.

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Medicare
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Hyperparathyroidism

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 Hyperparathyroidism.

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Clinical Documentation Improvement
  
Provider Alerts - Plans & Benefits - Policy, Billing, or Coverage Update - 2023
Important: Recertifications are Resuming in 2023

New York State will resume eligibility reviews and renewals for members of with a recertification date after June 2023. If your patients do not renew on time, they risk losing health coverage and could face unexpected costs or even a gap in care. This Provider Alert contains instructions on how members can renew their coverage...

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Recertification
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Metastatic Cancer/ Secondary Malignant Neoplasm

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 Metastatic Cancer/Secondary Malignant Neoplasm.

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Clinical Documentation Improvement
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2023
Book 4: Autism Spectrum Disorders for the Primary Care Practitioner and Other Providers

(Conference Book 4) Virtual Continuing Medical Education (CME) Conference: Autism Spectrum Disorders for the Primary Care Practitioner and Other Providers This event is jointly offered by Healthfirst and SUNY Downstate Health Sciences University.

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2023
Book 3: Autism Spectrum Disorders for the Primary Care Practitioner and Other Providers

(Conference Book 3) Virtual Continuing Medical Education (CME) Conference: Autism Spectrum Disorders for the Primary Care Practitioner and Other Providers This event is jointly offered by Healthfirst and SUNY Downstate Health Sciences University.

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Provider Events
  
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