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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2023
Authorization Requirement Update for Vision Services

Effective May 1, 2023, Healthfirst no longer requires authorization for selected vision services.

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Authorization
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-075v1 Laboratory Procedures

To be considered for reimbursement, all outpatient laboratory claims should be submitted in accordance with: - AMA CPT and HCPCS coding and ICD-10 diagnosis coding guidelines - Other laboratory and pathology coding guidelines - All applicable regulatory guidelines This policy outlines additional requirements beyond the guidelines listed above that are required for reimbursement. Note that these guidelines are reviewed and updated periodically.

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2023
Introducing Coding Validation from Cotiviti

Effective Sept. 1, 2023, consistent with the recommendations of the Office of Inspector General and the Centers for Medicare & Medicaid Services, Healthfirst will implement Cotiviti’s Coding Validation, an enhanced program based on nationally sourced guidelines regarding modifier usage.

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Reimbursement
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Myasthenia Gravis

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 myasthenia gravis.

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Clinical Documentation Improvement
  
Provider Alerts - Education Events & Patient Care Resources - Behavioral Health and Foster Care - Provider Resources - 2023
Children’s Home and Community-Based Services (HCBS) Frequently Asked Questions

Children's Home and Community-Based Services (HCBS) are provided in the community and help children and youth be successful at home, in school, and in other environments. HCBS are personal and flexible and are meant to meet the physical health, behavioral health, and/or developmental needs of each child/youth.

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Children & Family
  
Provider Alerts - Coding - Policy, Billing, or Coverage Update - 2023
Acceptable Procedure Code/Modifier Combinations

Effective Sept. 1, 2023, Healthfirst is updating internal systems to deny procedure code/modifier combinations that are specifically flagged as invalid or inactive. These changes are based on New York State Medicaid (NYSM), American Medical Association (AMA), and Centers for Medicare & Medicaid Services (CMS) guidelines.

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Coding
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2023
Day 2: Sixth Annual World Health Continuing Medical Education Conference

(Day 2 booklet) The theme for the June 16-17, 2023, Sixth Annual World Health Continuing Medical Education Conference is Health Disparities Impacting Global and Local Caribbean Populations

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2023
Day 1, panel 4: Sixth Annual World Health Continuing Medical Education Conference

(Day 1, panel 4 booklet) The theme for the June 16-17, 2023, Sixth Annual World Health Continuing Medical Education Conference is Health Disparities Impacting Global and Local Caribbean Populations

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2023
Day 1, panels 2-3: Sixth Annual World Health Continuing Medical Education Conference

(Day 1, panels 2-3 booklet) The theme for the June 16-17, 2023, Sixth Annual World Health Continuing Medical Education Conference is Health Disparities Impacting Global and Local Caribbean Populations

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2023
Day 1, panels 1: Sixth Annual World Health Continuing Medical Education Conference

(Day 1, panels 1) The theme for the June 16-17, 2023, Sixth Annual World Health Continuing Medical Education Conference is Health Disparities Impacting Global and Local Caribbean Populations

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Provider Events
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Major Depressive Disorder

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 Major Depressive Disorders.

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Clinical Documentation Improvement
  
Provider Alerts - Policy, Billing, or Coverage Update - 2023
Change in Level of Service Determinations and Prior Authorizations for Assertive Community Treatment

Effective June 20, 2023, Healthfirst, in accordance with the State of New York, will no longer require Level of Service Determinations (LOSD) or prior authorization for Assertive Community Treatment (ACT)

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ACT
  
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