HF Logo HF Logo
Provider Home

Search

Resource Type
Clear All
Filter
Year
Sort By
Showing 313-324 of 639
Provider Alerts - Pharmacy Resources & Formularies - Policy, Billing, or Coverage Update - 2023
NYRx Transition Fill Period Ending

Effective April 1, 2023, Medicaid members enrolled in Medicaid Managed Care (MMC) Plans, Health and Recovery Plans (HARP), and HIV-Special Needs Plans (SNPs) began receiving their pharmacy benefits through NYRx, the Medicaid Pharmacy program.

Open document
Pharmacy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-073v1 Ordering/Referring Provider NPI

The NPI number of the ordering/referring provider should be included in all claim’s submissions to Healthfirst for member service requests. Federal regulations require you to submit HIPAA standard electronic transactions with only your NPI number.

Open document
Reimbursement Policy
  
Provider Alerts - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2023
BH | Prior Authorization Guidelines

Review this provider alert for BH prior authorization guidelines that apply to in-network providers only.

Open document
Prior Authorization
  
Plans & Benefits - Practice Guidelines and Tips - 2024
Healthfirst at a Glance - Medicaid Managed Care

A New York State-sponsored Medicaid plan for low-income individuals, families, and children.

Open document
At a Glance
  
Plans & Benefits - Practice Guidelines and Tips - 2024
Healthfirst at a Glance - Child Health Plus (CHPlus)

A New York State-sponsored health plan for individuals under the age of 19.

Open document
At a Glance
  
Plans & Benefits - Practice Guidelines and Tips - 2024
Healthfirst at a Glance - Personal Wellness Plan (PWP)

For Medicaid beneficiaries with serious mental health illness and/or substance use disorders.

Open document
At a Glance
  
Provider Alerts - Behavioral Health and Foster Care - Plans & Benefits - Practice Guidelines and Tips - 2023
FAQ: Health and Recovery Plans (HARP) and Healthfirst’s Personal Wellness Plan (PWP)

See answers to frequently asked questions about Health and Recovery Plans and Healthfirst’s Personal Wellness Plan.

Open document
HARP Health And Recovery Plan
  
Diabetes & Prediabetes Care for Your Patients - Practice Guidelines and Tips - 2023
Healthfirst Cares Powered by Welldoc App Patient Referral Form

Providers can use the Healthfirst Cares Powered by Welldoc App Referral Form to refer any Healthfirst member who may benefit from the app’s diabetes and prediabetes self-management tips tools and program resources. Completed forms should be submitted via email to: welldocreferrals@healthfirst.org. Please contact your Network Account Manager with questions.

Open document
HF Cares
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2023
New Prior Authorization Guidelines for Select Services

Effective Nov. 1, 2023, Healthfirst will change its authorization guidelines for select services due to newly created codes on the CMS code list. As of that date, the services requiring prior authorization will include spinal surgery services managed through OrthoNet™, as well as radiation therapy and laboratory services managed through eviCore.

Open document
Prior Authorization
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-077v1 Photochemotherapy

Effective September 1, 2023, consistent with the American Academy of Dermatology Association and New York State, Healthfirst will update our policy regarding covered diagnoses for photochemotherapy treatment.

Open document
Reimbursement Policy
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Pulmonary Fibrosis

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 pulmonary fibrosis.

Open document
Clinical Documentation Improvement
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Spinal Cord Injury

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 spinal cord injury.

Open document
Clinical Documentation Improvement
  
You are now navigating away from the Healthfirst website.

Links to non-Healthfirst websites are provided for your convenience only. Healthfirst is not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.