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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2020
Healthfirst Reimbursement Policy Updates - Effective December 1, 2020

Effective December 1, 2020, several changes will be made to our reimbursement policy to maintain compliance with industry-accepted coding and reimbursement practices as well as state and national regulatory requirements.

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Reimbursement
  
Coding - Coronavirus (COVID-19) - Practice Guidelines and Tips - 2021
Coding Novel Coronavirus: Type COVID-19

This document provides guidance on proper coding practices for a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19). Please note that Healthfirst guidelines related to waiving the cost share for evaluating a member for suspected COVID-19 are not reflected within this coding guidance. Please refer to the Coronavirus (COVID-19) section at hfproviders.org to find information on claims/encounters that will result in the waiver of cost sharing for members.

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COVID-19
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
Healthfirst Reimbursement Policy Updates Effective April 1, 2020

Healthfirst Reimbursement Policy Updates

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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
Healthfirst Reimbursement Policy Updates

Effective November 1, 2021, several changes will be made to our reimbursement policy to maintain compliance with industry-accepted coding and reimbursement practices, as well as state and national regulatory requirements.

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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
Prior Authorization: Home Visits - Effective February 1, 2021

Effective February 1, 2021, Healthfirst will require prior authorization for the codes listed in the document related to home visits. Claims for these services and other types of service will not be paid without prior approval. The authorization required for each visit remains open for 30 days.

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Prior Authorization
  
Provider Alerts - Coronavirus (COVID-19) - Practice Guidelines and Tips - 2021
Healthfirst Utilization Management

On December 23, 2020, the New York Department of Financial Services (DFS) issued Insurance Circular Letter No. 17, Coronavirus and the Suspension of Certain Utilization Review and Notification Requirements under the “Surge and Flex” Protocol. Access this document to learn about what Healthfirst is doing in response to this protocol and for more information.

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Utilization Review
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
0077 21 Provider Alert Anesthesia Unit Policy v3 1 FINAL

Anesthesia services (00100–01999) are limited to a specific number of units per member, per provider group, per day. These limits are considered “typical” but may not reflect the actual services provided. If units are billed beyond our established limits, the total units allowed will be adjusted to the assigned maximum allowed; all other units will be denied. However, additional units can be considered for payment with supporting documentation upon appeal.

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Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
0078 21 Provider Alert Ambulance Diagnosis Policy v3 1 FINAL

Per CMS LCD L35162 (Jurisdiction H and L), emergency ambulance services (A0425–A0434) are a covered benefit when the services meet the medical necessity requirements as outlined in the CMS manuals and Federal Register sections listed in the CMS National Coverage Policy section indicated in this document. Providers should report the most appropriate ICD-10 code that adequately describes the patient’s medical condition at the time of transport as the primary diagnosis. 40TIn addition, a secondary diagnosis must be reported to indicate that transportation by any other means is medically contraindicated.

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Reimbursement
  
Provider Alerts - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2022
COVID-19 Coding Update for CPT 99072

Healthfirst aims to ensure that our reimbursement policy standards are up to date and compliant with state and national industry standards. Effective immediately, Healthfirst will not reimburse for CPT code 99072.

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COVID-19
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2021
0370 21 Reimbursement Policy Updates for 6121 v5

As a part of Healthfirst’s continuing efforts to ensure that our reimbursement policy standards are up to date and compliant with state and national industry standards, effective June 1, 2021, several changes will be made to our reimbursement policy. These changes will maintain compliance with industry-accepted coding and reimbursement practices, as well as state and national regulatory requirements. Policy updates for: Polysomnography and Sleep Studies, Unattended Polysomnography and Sleep Studies, and Home Polysomnography and Sleep Studies.

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Reimbursement
  
Quality Program Resources - Education Events & Patient Care Resources - Coronavirus (COVID-19) - General Update - 2021
Bringing Patients Back to Get the Care They Need

Getting care in a timely manner leads to better health outcomes. Outreach your patients/Healthfirst members directly to schedule appointments and prioritize patients who are overdue for a visit or screening/exam.

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Patient Resource
  
Provider Alerts - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2021
Delayed: Applied Behavioral Analysis (ABA) Benefit Carve Out

The October 1, 2021 Applied Behavioral Analysis (ABA) benefit carve out into Managed Medicaid has officially been postponed by New York State Department of Health. Providers should continue to submit claims for ABA services to Medicaid Fee-For-Service directly until further notice.

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Medicaid
  
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