Claims and Billing | Healthfirst

Claims and Billing

We want to make working with us easy and convenient. Whether you’re a provider or in-office staff, you’ll find everything you need on billing and reimbursement right here.

The policies, procedures, and other information in this section are part of the Healthfirst Provider Manual, and are available here for ease of use.

  • Healthfirst’s Partnership with HMS

  • Privileging of Providers to Offer Telehealth Services

  • 12/16/2019 - Authorization Requirement Update for Vision Services

  • 12/13/2019 - Coverage of Genetic Testing- Provider Alert

  • 12/5/2019 - Changes to the Negative Balance Process - Provider Alert

  • 12/3/2019 - Billing Guidance for Genentech Products – Herceptin, Xolair, Avastin, Perjeta

  • 11/15/2019 - Improved Payment Integrity Solutions

  • 11/01/2019 - Authorization Requirement Update for Echocardiography Services

  • 11/01/2019 - Online Authorization Tool – Requesting Prior Authorization for Medical Benefit Specialty Drugs

  • 11/01/2019 - Important Notice Regarding Endovenous Ablation Therapy of Incompetent Veins

  • 11/01/2019 - New Prior Authorization Requirement for Select Pathology Codes

  • 11/01/2019 - Healthfirst Reimbursement Policy for Elective Deliveries

  • 10/04/19 - Radiology Services Provider Alert

  • 09/17/19 - Vaccines for New York State Medicaid-Enrolled Children

  • 03/01/19 - Healthfirst Reimbursement Policies for Nurse Practitioners and Physician Assistants

  • 01/30/19 - Removal of Impacted Cerumen

  • 01/20/19 - 2019 eviCore Radiology and Radiation Therapy Code List

  • 05/22/18 - OrthoNet Codes Requiring Authorization: Pre-Certification Expansion - Interventional Vascular

  • 04/19/18 - Licensed Home Care Service Agencies (LHCSA) Billing and Authorization Guide

  • 11/15/18 - Out-of-Network Reimbursement Rate

  • 01/09/18 - OrthoNet Codes Requiring Authorization

  • 11/29/17 - Healthfirst/Health Management Systems (HMS) Provider Disallowance Program

  • 02/23/17 - 2015 Superior Vision: Codes Requiring Authorization

  • Superior Vision Authorization Requirements

  • 11/07/16 - National Drug Code (NDC) Billing—Policy Update

  • 05/10/16 - Corrected Claims Submissions FAQ

  • 01/05/16 - BH Carve-in | Prior Authorization Guidelines

  • 12/04/15 - NDC Billing Requirements 340b Provider Alert

  • 11/20/15 - Skilled Nursing Facility Billing Guidelines

  • 02/02/15 - Billing Guidance: Inpatient Nursing Home Services

  • 01/28/15 - Observation Stay Billing Guidelines

  • 12/30/14 - New Payment Policies on Drugs & Bio Agents

  • 12/03/14 - New CMS Modifiers for Distinct Procedural Services (59 Modifier)

  • 10/15/14 - Bilateral Billing Procedure Guidelines

  • 09/03/14 - Proper Use of Modifier "-25"

The claims processing experience should be as painless as possible. Learn more below about how to enroll in the program, submit claims electronically, and more.


Claims must be filled within 180 days of the date of service. You may submit either electronic or paper claims.

Providers should submit paper claims to:Healthfirst ClaimsP.O. Box 958438Lake Mary, FL 32795

Healthfirst encourages providers to file online claims and accepts both institutional and professional claims this way. Electronic filings are submitted through the Electronic Data Interchange (EDI) utilizing the Emdeon claims clearinghouse (formerly Web-MD).

Providers who don’t have claims submission software may sign up for a free online account with MD Online to begin filing electronically. Once on the MD Online site, click on Claims Submission, under Provider Services, to register.

Timely filing for all out-of-network (OON) Medicare claims is one (1) calendar year.
Reimbursement and Reconciliation

The Electronic Funds Transfer (EFT)/ Electronic Remittance Advice (ERA) program offers convenient services that enable direct deposit and automated documentation of Healthfirst claim payments.

With EFT, reimbursements are wired directly into your account. This means no lost checks, no deposit slips to prepare, and no waiting for checks to clear.

ERA is your digital Explanation of Benefits, an electronic statement that reduces your paperwork and allows you to easily reconcile reimbursements to your patient accounts.

Claims Process Additional Resources
  • Assistance for Medicare Retro-Disenrollment Notices

  • List of Claim Modifiers

  • Submission FAQ

  • Reimbursement FAQ

  • Waiver of Liability Statement

Commonly Used Codes
  • Acceptable Codes for Chlamydia Screening

Clinical Documentation and Coding Tips