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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
  
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.

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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.

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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.

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Prior Authorization
  
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