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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Healthfirst Reimbursement Policy Updates - Effective March 1, 2022

As a part of Healthfirst’s continuing efforts to ensure that our reimbursement policy standards are up to date and compliant with state and national industry standards, our reimbursement policy will undergo several changes effective March 1, 2022. These changes will maintain compliance with industry-accepted coding and reimbursement practices, as well as with state and national regulatory requirements.

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Documentation
  
Behavioral Health and Foster Care - Practice Guidelines and Tips - 2022
CORE Transition: Important Workflow Reminders and FAQs

Effective February 1, 2022, New York State received federal approval to transition four Behavioral Health Home and Community Based Services (BH HCBS) to a new service array called Community Oriented Recovery and Empowerment (CORE) services.

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Behavioral Health
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Changes to Authorization Guidelines for Selected Medical Services

Effective April 1, 2022, Healthfirst will change its authorization guidelines 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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Prior Authorization
  
Provider Alerts - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2022
New York Medicaid Guidance for Billing Monoclonal Antibody Treatments

New York State (NYS) Medicaid will reimburse NY Medicaid-enrolled pharmacies for administration or dispensing of COVID-19 therapeutics, including monoclonal antibody (mAb) treatments with no member cost share.

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COVID-19
  
Provider Alerts - Policy, Billing, or Coverage Update - 2022
Prior Authorization Waiver Expiration: Post-Acute Discharge

Effective December 31, 2021, Healthfirst has waived authorization requirements for transfers or discharges from an acute inpatient facility to another acute inpatient facility, a skilled nursing facility (SNF), acute rehabilitation facility (AR), or long-term acute care hospital (LTACH).

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Prior Authorization
  
Provider Alerts - Policy, Billing, or Coverage Update - 2022
Healthfirst Reimbursement of Developmental Screening in Primary Care

Effective April 1, 2022, Healthfirst will begin to reimburse Developmental Screening (CPT 96110) in primary care as per New York State Medicaid guidance.

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Reimbursement
  
Coding - Practice Guidelines and Tips - 2022
Documentation and Coding: Multiple Sclerosis

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 multiple sclerosis (MS).

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Clinical Documentation Improvement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Healthfirst Policy for the Authorization of Applied Behavioral Analysis (ABA) Services

Healthfirst’s medical policies are intended to provide guidance in the administration of Healthfirst’s benefit plans and are used by medical directors and other clinical professionals in making medical necessity and other coverage determinations. This policy is applicable to the Commercial Plan, Qualified Health Plan (QHP), Essential Plan (EP) and Child Health Plus (CHP). While this service is not covered by Healthfirst Medicaid Managed Care Plan, ABA services are available to Medicaid beneficiaries through Medicaid Fee-for-Service.

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Billing Guidance for Acupuncturists

Medicare covers acupuncture for chronic lower back pain. Plans must offer this benefit and can choose to offer a supplemental benefit in addition to the original Medicare-covered visits. Previously, most Healthfirst providers submitted claims for acupuncture visits using ICD-10 M54.5. However, this ICD was retired on October 1, 2021.

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Billing
  
Behavioral Health and Foster Care - Practice Guidelines and Tips - 2022
Children’s Home and Community-Based Services Frequently Asked Questions

Children’s Home and Community-Based Services (HCBS) are for children and youth who need extra care at home/in the community and want to avoid going to the hospital or a long-term facility. Review these important workflow reminders, answers to questions you may have about HCBS, and other helpful resources

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Behavioral Health
  
Provider Alerts - Claims & Billing - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2022
Child HCBS Authorizations and Reminder of State Billing and Claiming Requirements

This notice is to remind Children’s Home and Community-Based Services (HCBS) providers of HCBS billing and claiming requirements, per the April 4, 2022, NYSDOH memo.

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Billing
  
Provider Alerts - Pharmacy Resources & Formularies - Coronavirus (COVID-19) - Provider Resources - 2023
New York State Medicaid Coverage Criteria for Pharmacists Providing COVID-19 Vaccine Counseling

The New York State Department of Health issued guidance that New York State Medicaid will reimburse COVID-19 vaccination counseling to Medicaid members/enrollees by pharmacists in order to encourage vaccination against COVID-19. The effective date of coverage is for dates of service on or after December 1, 2021.

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Medicaid
  
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