News and Intelligence

September 9, 2020

NYS Medicaid has alerted Practicefirst that all providers who participate in the NYS Vaccine Program are required to complete an annual re-enrollment application.  Beginning this year, re-enrollment is being done electronically using the NYS Immunization Information System (NYSIIS).  Each participating provider organization is responsible for reviewing and updating the Provider Agreement, Pro...

March 4, 2020

Univera Healthcare

Practicefirst was recently notified by Univera of the following administrative policy effective May 15, 2020, to define the billing and reimbursement guidelines for increased procedural services (i.e., modifier 22) billed on professional claims. This policy is in line with the Centers for Medicare & Medicaid Services and CPT guidelines.

The new policy will apply to all practitione...

December 30, 2019

Practicefirst was recently notified by Univera of a new administrative policy effective March 15, 2020, to define the coverage and billing guidelines for preventive services billed on the same day as a problem-oriented visit by the same individual provider for the same member. This policy is in line with the Centers for Medicare & Medicaid Services and Current Procedural Terminology (CPT) guidelin...

November 8, 2019

Practicefirst has been notified that Univera will be introducing a new electronic authorization tool to replace the current tool, Clear Coverage. 

“CareAdvance Provider”, a web-based real time software tool is tentatively scheduled to launch sometime in the fourth quarter of 2019 , beginning with Medicaid Managed Care, Child Health Plus and HARP lines of business.  The  Commercial and Medicare line...

March 12, 2019

If you are participating in Medicare’s MIPS (Merit-based Incentive

Payment System) or an advanced APM (Alternative Payment Model), please let Practicefirst know what measures you’ve reported and for which years so we can monitor your Medicare payments for the proper payment adjustment.  For more information about Medicare’s quality payment programs (QPP), including whether or not you’re required to...

February 6, 2019

Practicefirst has been notified that CMS is halfway through the transition period that began April 1, 2018 for distribution of new Medicare Beneficiary Cards. 

  • To ensure your Medicare patients continue to get care, you can use either the former Social Security number-based Health Insurance Claim number (HIC) or the new alpha-numeric Medicare Beneficiary Identifier (MBI) for all Medicare transac...

January 9, 2019

Practicefirst has just been made aware of a third plan option for the Blue Cross/Blue Shield Federal Employee Program.  Effective January 1, 2019 FEP Blue Focus will become available as a plan offering low premiums and copay's for every day healthcare needs.  The plan covers preventive essentials (in-network only), including:

  • The first ten doctor and specialist visits for $10 each

  • Gen...

December 7, 2018

Practicefirst would like to make you aware of Pre-payment Reviews currently underway for Railroad Medicare.

These reviews are currently being conducted through September 2019 for the following E&M codes: 99204, 99205, 99222, 99223, 99231, 99232, 99233, 99284, 99285, 99291, 99308 and 99309. They are also reviewing the following Radiology codes: 71045, 71046 and 77080, as well as Therapy services. Th...

December 7, 2018

Practicefirst would like to share with you the latest news from Railroad Medicare. The goal of Palmetto GBA’s (Railroad Medicare) medical review program is to ensure that payment is only made for services that meet all Medicare coverage guidelines, coding and medical necessity requirements. The following are the 10 most common provider errors identified in the 4th fiscal quarter of 2018:

  • Altern...

August 13, 2018

Practicefirst has received updated information regarding Independent Health’s Primary Value reimbursement program for primary care advances in 2019.  This program began in January 2018 as an initiative to invest and partner with primary care physicians through value-based reimbursement. 

Primary Value consists of two forms of reimbursement, including global per-member, per-month and fee-for-se...

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