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Provider Alerts - Claims & Billing - Coronavirus (COVID-19) - Telehealth - Policy, Billing, or Coverage Update - 2022
Coronavirus: Telehealth Policies FAQ

Did you know that providers need to be approved by Healthfirst to continue qualifying for reimbursement of telehealth services? Access our FAQs to learn more.

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COVID-19
  
Provider Alerts - Claims & Billing - Coronavirus (COVID-19) - 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.

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COVID-19
  
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 - 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 - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
Pharmacy Billing Guidance for COVID-19 Vaccine Under Healthfirst’s Medicaid Managed Care Plan (MMC) and Personal Wellness Plan

During the declared State of New York 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 (MMC) and Personal Wellness Plan (PWP). View PDF for billing instructions.

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Personal Wellness Plan
  
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
  
Quality Program Resources - Coronavirus (COVID-19) - Patient Care Resources - 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 - Coronavirus (COVID-19) - General Update - 2022
COVID-19 Vaccine Counseling Program

In accordance with Medicaid COVID-19 vaccine regulations, Healthfirst will reimburse eligible providers for vaccine counseling rendered to unvaccinated Medicaid and HARP members/enrollees during dates of service on or after December 1, 2021. For providers located in New York City, this coverage essentially replaces the Vaccine Outreach and Counseling Program (VOCP) Healthfirst launched in collaboration with the New York City Department of Mental Hygiene in the fall of 2021, and which ended on December 31, 2021. If you provided services under the VOCP and have not yet billed for them, please bill in accordance with the requirements of the VOCP

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COVID-19
  
Coronavirus (COVID-19) - Patient Care Resources - Practice Guidelines and Tips - 2022
The Flu and COVID-19 Frequently Asked Questions

Now that flu season is approaching, it's important to remember that the COVID-19 pandemic is still continuing around the world.

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Seasonal Flu
  
Provider Alerts - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2023
Billing Guidance for COVID-19 Vaccine Under Healthfirst’s Plans

Healthfirst continues to monitor COVID-19 vaccine updates from the state and federal government and from other healthcare agencies. This guidance provides billing information on COVID-19 vaccines. (Updated June 2023)

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Billing
  
Provider Alerts - Claims & Billing - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2021
Coronavirus: Type (COVID-19) — Cost-Sharing Waiver

Please be advised that the New York State Department of Financial Services, the New York State Department of Health, and the federal government have directed Healthfirst to waive patient copayments, coinsurance, and deductibles for certain testing and treatment due to the coronavirus (COVID-19) emergency.

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COVID-19
  
Provider Alerts - Coronavirus (COVID-19) - Pharmacy Resources & Formularies - Provider Resources - 2023
COVID-19 Vaccine Additional Doses for Immunocompromised Individuals Pharmacy Billing Guidance

On August 13, 2021, the Advisory Committee on Immunization Practices (ACIP) met and recommended an additional dose for immunocompromised individuals who have received the Pfizer-BioNTech or Moderna COVID-19 vaccine.

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Emergency Use Authorization
  
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