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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Changes to OASAS Comprehensive Outpatient Treatment Programs and Updated Billing Guidance

The New York State Office of Addiction Service and Supports (OASAS) is implementing several changes to integrate care within the OASAS outpatient clinic regulatory structure, including a merged Comprehensive Outpatient Treatment Program (COP) operating certificate, COP reimbursement updates, and inclusion of Opioid Treatment Program (OTP) bundles into APG methodology.

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Behavioral Health and Mental Health
Reimbursement
Medicaid
Healthfirst Plans
  
Provider Alerts - Policy, Billing, or Coverage Update - 2024
Two Additional Prior Authorization Codes Managed by EyeMed Effective Jan. 1, 2025

EyeMed manages Healthfirst’s prior authorization for surgical and therapeutic vision services as well as network management, related member and provider service calls, and claims payment for routine vision and medical optometry services. Starting Jan. 1, 2025, EyeMed will manage prior authorization for J2777 and J0177.

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Administration
Authorization
Dental and/or Vision
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Enhancing Claims Processing Accuracy with ClaimsXten

ClaimsXten (CXT) is an industry-leading claims editing software that adjudicates claims more efficiently and aligns with Healthfirst standards. Review the provider alert for more information on CXT, including updated frequently asked questions.

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Administration
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2024
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective Jan. 1, 2025

Starting Jan. 1, 2025, Healthfirst will change its authorization guidelines for select CPT and HCPCS codes. See the Provider Alert for a list of codes that will now require prior authorization.

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Administration
Authorization
  
Behavioral Health and Foster Care - Practice Guidelines and Tips - 2024
Foster Care Provider Education Letter

This letter outlines key guidance providers should be mindful of when delivering care to Medicaid enrolled children/youth in direct placement foster care and in the care of Voluntary Foster Care Agencies.

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Medicaid
  
Documentation & Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Thyroid Cancer, 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 Thyroid Cancer.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2020
Vaccine Schedules For You and Your Family

Stay up to date on getting recommended vaccines for you and your family.

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Vaccines
  
Provider Alerts - Practice Guidelines and Tips - 2024
Healthfirst’s Eligibility Search Tool Will Fully Transition to Availity

Starting October 1, 2024, Healthfirst’s Eligibility Search tool will be accessible only through Availity Essentials. Access to the Eligibility Search tool via HFproviderportal.org will end after September 30, 2024, and providers will be redirected to log into Availity Essentials.

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Administration
  
Quality Program Resources - Practice Guidelines and Tips - 2024
Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States

Each year CDC estimates the burden of influenza in the U.S. CDC uses modeling to estimate the number of flu illnesses, medical visits, hospitalizations, and deaths related to flu that occurred in a given season.

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Vaccines
  
Documentation & Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Social Determinants of Health

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection of services submitted to Healthfirst—specifically for Social Determinants of Health.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Coma, 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 Coma.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2020
Institute for Healthcare Improvement
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Documentation
  
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