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Provider Alerts (General Update) - 2021
COVID-19 Vaccine Counseling Program

Healthfirst is committed to ensuring our members are educated around the importance of taking the COVID-19 vaccine. In partnership with the NYC Department of Health and Mental Hygiene (NYCDOHMH), under the Vaccine Outreach and Counseling Program (VOCP) Healthfirst will reimburse eligible PCPs for outreach phone calls to counsel their Healthfirst patients on the COVID-19 vaccine.

COVID-19 Vaccine Counseling Program

Provider Alerts (Policy, Billing, or Coverage Update) - 2021
COVID-19 Testing — Billing Guidance

Healthfirst will cover medically appropriate COVID-19 testing at no cost share during the public health emergency when such testing is ordered by a physician or licensed healthcare professional for the purpose of diagnosis or treatment of COVID-19.

COVID-19

COVID-19 Testing — Billing Guidance

Provider Alerts (Policy, Billing, or Coverage Update) -
Superior Vision Authorization Requirements

Effective January 1, 2015, these list of codes do not require initial authorization unless done in an outpatient Ambulatory Service Center (ASC). All follow-up services will also require authorization.

Authorization

Superior Vision Authorization Requirements

Provider Alerts (Policy, Billing, or Coverage Update) - 2021
Medicare Monoclonal Antibody COVID-19 Infusion Program

On April 16, 2021, the U.S. Food and Drug Administration (FDA) revoked the emergency use authorization (EUA) for bamlanivimab when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients.

COVID-19

Medicare

Medicare Monoclonal Antibody COVID-19 Infusion Program

Provider Alerts (Policy, Billing, or Coverage Update) - 2021
Introducing ClaimsXten™

Effective June 2021, Healthfirst will launch ClaimsXten (CXT), an industry-leading claims-editing software from Change Healthcare that will update and expand on Healthfirst’s current claims-editing processes. CXT will adjudicate claims more efficiently and in a manner that aligns with industry standards.

Introducing ClaimsXten™

Provider Alerts (Policy, Billing, or Coverage Update) - 2021
Healthfirst Reimbursement Policy Updates - Effective June 1, 2021

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.

Reimbursement

0370 21 Reimbursement Policy Updates for 6121 v5

Provider Alerts (Policy, Billing, or Coverage Update) - 2021
Privileging of Providers to Offer Telehealth Services

Healthfirst has established a policy and application process to enable our network of contracted providers to offer telehealth services to our members to improve access to care and outcomes of care. The policy and application process detailed herein is applicable to all providers and vendors who wish to render telehealth services.

Privileging of Providers to Offer Telehealth Services

Provider Alerts (Policy, Billing, or Coverage Update) - 2021
Coding for UroCuff

Healthfirst requires specific coding to bill for the use of the UroCuff. This applies to all Healthfirst providers for all Healthfirst products.

Coding for UroCuff

Provider Alerts (General Update) - 2021
COVID-19 Vaccination: Eligibility and Resources

Healthfirst remains committed to ensuring our providers stay up-to-date on eligibility requirements for the COVID-19 vaccine.

COVID-19 Vaccination: Eligibility and Resources

Provider Alerts (Policy, Billing, or Coverage Update) - 2021
Pharmacy Billing Guidance for COVID-19 Vaccine Under Healthfirst’s Medicaid Managed Care Plan (MMC) and Personal Wellness Plan

Per New York Governor Cuomo’s Executive Order #202, during the declared disaster emergency, pharmacies may bill for COVID-19 vaccines that have been authorized by the FDA under Emergency Use Authorization (EUA) under Healthfirst’s Medicaid Managed Care Plan and Personal Wellness Plan. As additional COVID-19 vaccines become available under an EUA, or are otherwise approved by the FDA, this billing guidance will be updated as needed.

Personal Wellness Plan

Pharmacy Billing Guidance for COVID-19 Vaccine Under Healthfirst’s Medicaid Managed Care Plan (MMC) and Personal Wellness Plan

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