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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Changes to the Healthfirst Connection Plan (HMO D-SNP) and Life Improvement Plans Beginning in 2025

Starting January 1, 2025, Providers will need to bill Medicaid Fee-for-Service or Member’s Medicaid Coverage for Healthfirst Connection Plan Members’ cost sharing.

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Medicaid
Medicare
Reimbursement
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Hepatitis C, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model Updates, on services submitted to Healthfirst—specifically for chronic Hepatitis C.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Provider Alerts - Practice Guidelines and Tips - 2024
Scheduling Configuration Changes for Linked and Mutual Visits

Starting January 1, 2025, Healthfirst is creating new service code configurations to accurately account for Linked and Mutual Visits.

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Administration
Authorization
Licensed Home Care Services Agencies
Medicaid
  
Plans & Benefits - Practice Guidelines and Tips - 2024
Healthfirst Member ID Cards

View Healthfirst Member ID Cards at a glance.

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At a Glance
  
Plans & Benefits - Practice Guidelines and Tips - 2024
Healthfirst at a Glance - The Essential Plan

Federally subsidized plans for individuals who are ineligible for Medicaid due to income or immigration status.

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At a Glance
  
Provider Alerts - Provider Resources - 2024
Diabetes Cost-Sharing Reduction for Essential Plan, Leaf Plan, and Leaf Premier Plan Members

Starting January 1, 2025, New York State of Health is implementing a Diabetes Cost-Sharing Reduction initiative to make services more accessible and affordable. Learn more about these cost-sharing reductions in this Provider Alert...

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Cost Sharing
Diabetes
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-126 Diabetes Cost-sharing Waiver

This policy outlines Healthfirst’s reimbursement guidelines regarding the waiver of cost-sharing for Essential Plan (EP) and Qualified Health Plan (QHP) members diagnosed with Type 1, Type 2, or Gestational Diabetes. The intention of this policy is to promote access to necessary healthcare services and support for individuals managing diabetes. By waiving cost-sharing for specific services, Healthfirst aims to enhance diabetes management, improve health outcomes, and reduce long-term healthcare costs.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-122 Pasteurized Human Donor Milk Coverage

Healthfirst provides coverage for Pasteurized Human Donor Milk (PDHM) under certain programs/lines of business. This policy describes Healthfirst’s reimbursement guidelines for PDHM as it relates to both inpatient and outpatient settings.

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Reimbursement Policy
  
Diabetes & Prediabetes Care for Your Patients - Practice Guidelines and Tips - 2023
Healthfirst Cares powered by Welldoc® App Provider Alert

Healthfirst, in collaboration with Welldoc, has developed the Healthfirst Cares powered by Welldoc® App. The app is completely free and available to all Healthfirst members ages 18 and older diagnosed with diabetes and prediabetes. The Healthfirst Cares App delivers personalized, real-time feedback and self-management tips to help patients track their diabetes and prediabetes, while sharing crucial health data and insights with their provider care teams. This alert toplines valuable insights on the patient and provider benefits of the Healthfirst Cares App.

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HF Cares
  
Diabetes & Prediabetes Care for Your Patients - Practice Guidelines and Tips - 2023
Healthfirst Cares powered by Welldoc® App FAQs

View this document for answers to some of the most frequently asked questions about the Healthfirst Cares powered by Welldoc® App for diabetes and prediabetes self-management and prevention.

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HF Cares
  
Diabetes & Prediabetes Care for Your Patients - Practice Guidelines and Tips - 2023
Healthfirst Cares powered by Welldoc® App Capabilities Guide

The Capabilities Guide provides a detailed overview of the numerous diabetes and prediabetes self-management features and benefits of the Healthfirst Cares powered by Welldoc® App including: Personalized Digital Coaching, Personalized Reports, Clinically Based Education, Nutritional Guidance, and more! It also includes a QR Code to make it easy for your patients to scan and download the Healthfirst Cares App.

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HF Cares
  
Coding - Video - 2024
Video - Documentation and Coding of Peripheral Vascular Disease

This 5-minute video offers guidance on proper clinical documentation and coding of peripheral vascular disease.

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Clinical Documentation Improvement
Video
  
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