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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
  
Education Events & Patient Care Resources - Claims & Billing - 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
  
Education Events & Patient Care Resources - Policy, Billing, or Coverage Update - 2022
American Academy of Family Physicians Oral Health

As the first line of defense against preventable illness and disease, you play a key role in promoting good oral health during patient visits. The AAFP offers clinical resources to help you discuss the health risks associated with developing oral disease.

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Oral Health
  
Education Events & Patient Care Resources - Patient Resource - 2022
Oral Health Care During Pregnancy and Early Childhood Practice Guidelines
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Oral Health
  
Quality Program Resources - Practice Guidelines and Tips - 2022
Healthfirst Quality App (video)

See how the Quality App can help you track your quality metrics in a better way.

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HQIP
  
Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2023
Behavioral Health Managed Care Transition
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Behavioral Health
  
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