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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.

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HARP Health And Recovery Plan
  
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.

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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.

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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.

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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.

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Clinical Documentation Improvement
  
Provider Alerts - Coding - Practice Guidelines and Tips - 2023
Invalid ICD-10-CM Diagnosis Codes are Expiring

Healthfirst is updating our ICD-10-CM diagnosis code set to meet the specificity requirements established by the Centers for Medicare & Medicaid Services (CMS).

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Coding
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Parkinson's Disease, 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 Parkinson’s disease.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Provider Alerts - Claims & Billing - Coronavirus (COVID-19) - Telehealth - Policy, Billing, or Coverage Update - 2022
Coronavirus: Telehealth Policies FAQ

Did you know that providers need to be approved by Healthfirst to continue qualifying for reimbursement of telehealth services? Access our FAQs to learn more.

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COVID-19
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
Drug Testing Policy

Healthfirst aims to ensure that our policy standards are up to date and are compliant with state and national industry standards. Effective February 1, 2021, Healthfirst has limited the reimbursement of drug testing as outlined in this document.

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Reimbursement
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-041 Serum Tumor Markers for Malignancies

Tumor biomarkers are proteins detected in the blood, urine, or other body fluids that are either produced by the tumor itself or in response to its presence.

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Reimbursement Policy
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2020
Newborn Hearing Screening; Lost to Documented Follow-Up Considerations for the Medical Home
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Children & Family
  
Coding - Practice Guidelines and Tips - 2020
HCC Coding, Risk Adjustment, and Physician Income
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General ICD-10/ICD-11 Information
  
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