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.
Claims and Billing
The policies, procedures, and other information in this section are part of the Healthfirst Provider Manual, and are available here for ease of use.
12/02/2019 - Changes to the Negative Balance Process - 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
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.
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.
Acceptable Codes for Chlamydia Screening