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Pharmacy Resources & Formularies - Quality and Compliance - 2023
Pharmacy Carve Out Delay Announcement

The Pharmacy carve-out has been delayed by two years, until April 1, 2023. Review this DOH announcement to learn more.

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Medicaid
  
Quality Program Resources - Practice Guidelines and Tips - 2021
Checklist for HARP CAHPS Success

This document outlines ways you can improve your patients’ experience and help with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey that your Health and Recovery Plan (HARP) patients may receive this year. For your reference, the HARP CAHPS survey questions are also available in this document.

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HARP Health And Recovery Plan
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2021
Building the Future We Wish to See: Partnerships for Optimal Medical Outcomes in 2021 and Beyond

Healthfirst’s semi-annual Provider Symposium features the innovative work of practices, health care organizations and industry leaders who care for and serve our members. Providers, administrators, and leaders from a variety of ambulatory, community based, and independent health and social service settings look forward to attending and learning from colleagues and health leaders.

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Mental Health
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2021
The Business of Medicine in Primary Care in the Era of COVID-19: Part 1

This Continuing Medical Education activity is designed to update primary care and specialty practices on the evolving strategies for implementing value-based care, new primary care practice models, and evidence-based medicine to meet the needs of communities ravaged by the COVID-19 pandemic. The intent is to inform the attendees on best practices and innovations in addressing racial equity and the needs of special patient populations.

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2021
2021–2022 Seasonal Influenza Vaccine Codes

Based on the August 2021 guidance from the CDC, the CPT influenza vaccine codes in this document reflect updates to the recommendations on the use of seasonal influenza vaccines in the United States from the Advisory Committee on Immunization Practices (ACIP). Healthfirst’s benefit configurations have been updated to include this full range of vaccines.

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Annual Flu Vaccine
  
Coding - Practice Guidelines and Tips - 2021
Documentation and Coding: Atrial Fibrillation

At Healthfirst, we are committed to helping providers accurately document and code their patients’ health records. This tip sheet will offer guidance on how to submit diagnosis code with greater specificity for coding atrial fibrillation (AFib).

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Clinical Documentation Improvement
  
Claims & Billing - Policy, Billing, or Coverage Update - 2021
New CPT® Category III Codes

Healthfirst aims to ensure that our reimbursement policy standards are compliant with state and national industry standards. The American Medical Association (AMA) has released new Category III codes, effective July 1, 2021. As of this date, Healthfirst requires prior authorization for these codes.

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Reimbursement
  
Behavioral Health and Foster Care - Practice Guidelines and Tips - 2021
Children and Family Treatment and Support Services (CFTSS) FAQs

Children and Family Treatment and Support Services are a set of six children’s health and behavioral health Medicaid State Plan services that focus on prevention, early intervention, and access to clinical treatment. With CFTSS, eligible members will have more choices in how to approach rehabilitative intervention.

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Children & Family
  
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