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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-095 Anesthesia Services

Healthfirst Anesthesia policy is developed in part using the Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Policy Manual, CMS NCCI edits and the CMS Regional Physician Fee Schedule, American Society of Anesthesiologists guidelines, and its own medical policies regarding the coding of claims.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-90 ICD-10-CM Excludes1 Notes

Effective 04/01/2024, Healthfirst expects the ICD-10-CM Excludes1 Notes policy in accordance with the ICD-10-CM coding guidelines and the Medicare Claims Processing Manual governed by the Centers for Medicare and Medicaid Services (CMS) to be followed.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-087 General Principles of Lab Test Coverage

The purpose of this policy is to establish the standards and guidelines that Healthfirst follows when determining coverage of lab tests.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-082 Testing of Homocysteine Metabolism-Related Conditions

Homocystinuria is a metabolic condition in which the body is unable to properly process certain amino acids, resulting in an abnormal accumulation of homocysteine and its metabolites in the blood and urine (NIH, 2023).

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Reimbursement Policy
  
Plans & Benefits - Practice Guidelines and Tips - 2024
Healthfirst at a Glance - Personal Wellness Plan (PWP)

For Medicaid beneficiaries with serious mental health illness and/or substance use disorders.

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At a Glance
  
Plans & Benefits - Practice Guidelines and Tips - 2024
Healthfirst at a Glance - Medicaid Managed Care

A New York State-sponsored Medicaid plan for low-income individuals, families, and children.

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At a Glance
  
Plans & Benefits - Practice Guidelines and Tips - 2024
Healthfirst at a Glance - Child Health Plus (CHPlus)

A New York State-sponsored health plan for individuals under the age of 19.

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At a Glance
  
Coding - Policy, Billing, or Coverage Update - 2020
The ICD-10 Transition: Focus on Non-Covered Entities

The ICD-9 code set used to report medical diagnoses and inpatient procedures is being replaced by the ICD-10 code set. To accommodate the ICD-10 code structure, the standards used for electronic health care transactions, Version 4010/4010A, were upgraded to Version 5010 on January 1, 2012.

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General ICD-10/ICD-11 Information
  
Quality Program Resources - Practice Guidelines and Tips - 2024
Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States

Each year CDC estimates the burden of influenza in the U.S. CDC uses modeling to estimate the number of flu illnesses, medical visits, hospitalizations, and deaths related to flu that occurred in a given season.

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Annual Flu Vaccine
  
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
  
Patient Care Resources - Patient Resource - 2020
New York City Department of Parks & Recreation - Fitness

Looking to stretch yourself without stretching your wallet? Check out some of favorite free and low-cost ways to stay healthy. Whether your idea of a work out involves dance moves, heavy weights, or downward facing dogs, Parks has a fitness program for you.

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Weight Management
  
Plans & Benefits - Practice Guidelines and Tips - 2024
Healthfirst at a Glance - Signature (PPO)

A Medicare Advantage plan with the option to see out-of-network providers without a referral and/or prior authorization.

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At a Glance
  
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