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Provider Alerts - Practice Guidelines and Tips - 2024
Availity Essentials™: Provider Portal Transition FAQ

Starting July 2024, Healthfirst will begin launching our new Provider Portal through Availity Essentials. To ensure a smooth transition, we will continue to update our Frequently Asked Questions (FAQ) document to help you understand how this change will affect you and your practice.

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Administration
  
Provider Resources - 2024
Children’s Home and Community-Based Services (HCBS) FAQ

Children's Home and Community-Based Services (HCBS) are for children and youth who, if not receiving these services, would require the level of care provided in a more restrictive environment. In this FAQ you will find important workflow reminders, answers to questions you may have about HCBS, and other helpful resources.

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Children & Family
  
Provider Alerts - Provider Resources - 2024
Public Health Emergency (PHE) Flexibilities Related to the Medicaid Children’s Waiver and Health Home Services

The New York State Department of Health (NYSDOH) has issued guidance on Public Health Emergency (PHE) flexibilities. This includes important end dates for these flexibilities that providers you should be aware of. Although many emergency flexibilities expired with the official end of the COVID-19 PHE, others have an end date specified by New York State or a maximum period set by the federal government. Find details on all PHE flexibilities here...

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COVID-19
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Qualified Dietitians/Nutritionists Can Now Enroll and Bill Directly for Medical Nutritional Therapy

As of Jan. 1, 2024, qualified dietitians/nutritionists are allowed to enroll and bill directly for medically necessary Medical Nutritional Therapy (MNT) provided to eligible members for the following Healthfirst lines of business: Medicaid Managed Care, Personal Wellness Plan, Senior Health Partners Managed Long-Term Care Medicaid Plan, and Healthfirst CompleteCare (HMO D-SNP).

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Administration
  
Provider Alerts - Provider Resources - 2024
Lymphedema Compression Treatment Items Now Covered by Medicare

A new benefit category has been established for Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for standard and custom-fitted compression garments and additional lymphedema compression treatment items that are primarily and customarily used to serve a medical purpose.

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Medicare
  
Claims & Billing - Provider Resources - 2024
Healthfirst Clinical Guidelines 2024

Healthfirst wishes to be transparent in the clinical guidelines we use when reviewing authorizations. We are pleased to share a new feature on our Provider Portal: Clinical Guidelines. This tool outlines the clinical criteria Healthfirst uses to support member care decisions. Please note: Guidelines for authorizations managed by our delegated vendors can be found by visiting the respective delegated vendor websites. Please follow the steps outlined in this document to use this helpful new feature.

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Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
New York State Medicaid Guidance for Billing Respiratory Syncytial Virus (RSV) Vaccines

As of Oct. 1, 2023, New York State (NYS) Medicaid began reimbursing NYS Medicaid-enrolled providers for administration or dispensing of Respiratory Syncytial Virus (RSV) vaccines for adults and for the administration of nirsevimab for infants.

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Billing
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Updates on Coverage of Community Health Worker Services

Effective Oct. 1, 2023, Healthfirst will reimburse Community Health Worker (CHW) services for pregnant and postpartum people as a preventive medical service when billed under a Medicaid-enrolled supervising licensed provider. Medicaid, HARP, and Connection Plan members are eligible for CHW services during pregnancy and up to 12 months after the end of pregnancy, regardless of how the pregnancy ends. See the provider alert for additional updates.

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Billing
Reimbursement
  
Claims & Billing - Education Events & Patient Care Resources - Video - 2022
Child and Adolescent Behavioral Health in the Primary Care Setting

Project Teach – Maja Castillo, MD, MHA, AVP Pediatric Medical Director, Healthfirst Anxiety in Children & Adolescents – Victoria Johnson, MD, Associate Medical Director, Valera Health Resources and Best Practices: Pediatric Behavioral Health Referrals – Caroline Heindrichs

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Children & Family
  
Behavioral Health and Foster Care - Practice Guidelines and Tips - 2020
Behavioral Health Resources & Tools
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Compliance and Regulation
  
Education Events & Patient Care Resources - Video - 2022
Building the Future We Wish to See

On November 19, 2021, Healthfirst held its semiannual Fall Provider Symposium. The theme was “Building the Future We Wish to See: Partnerships for Optimal Medical Outcomes in 2021 and Beyond”.

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Provider Events
  
Education Events & Patient Care Resources - Patient Resource - 2022
American Dental Association Clinical Practice Guidelines and Dental Evidence
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Oral Health
  
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