NY Manual
SHP Manual

New York Provider Manual
8.1 Definition of Specialty Care | 9.2 Benefits and Access to Care

9. Behavioral Health Services

9.1 Description of the Network

Healthfirst has participation agreements with a broad network of providers and other licensed professionals, community agencies, and inpatient and outpatient facilities that specialize in the treatment and management of mental health and substance use disorders (together referred to as "Behavioral Health").

Healthfirst manages the Behavioral Health services for most of its members. However, some Healthfirst members receive Behavioral Health services based on the hospital system they have selected as their provider of choice, and Healthfirst has contracted with a third party that maintains their provider network, processes referrals, performs medical/utilization/case management, quality management, billing and claims payment. Regardless of who provides these services, Healthfirst retains programmatic and quality oversight of these delegated arrangements to ensure that members are being served appropriately.

Providers should use the phone numbers below for Behavioral Health services:

Behavioral Health/Chemical Dependency Affiliate
Provider
Healthfirst Plans Accepted
Phone Number
University Behavioral Health Associates (UBA) The Care Management Organization (CMO)
Montefiore Medical Center
 
Sound Shore Medical Center
 
The Mount Vernon Hospital
 
Elmhurst Hospital   

< Healthfirst members have Primary Care Provider through Montefiore

 

<  Healthfirst PHSP Members with Elmhurst providers

1-800-401-4822
Healthfirst Medical Management/Behavioral Health Department
Elmhurst Hospital
 
Healthfirst Participating Providers (excluding Montefiore affiliation)
< Elmhurst (Medicare and Leaf Plan members only)
 
<  Healthfirst members have non-Montefiore Primary Care Provider
 
1-888-394-4327
 

 

Providers may call the behavioral healthcare management systems for the hospitals listed above to obtain services at 1-800-401-4822 or they may contact the Healthfirst Medical Management Department at 1-888-394-4327 to facilitate access to services. Providers may contact Member Services at the phone numbers listed in Section 1 to determine a member’s hospital affiliation or to obtain information about participating behavioral health providers.

Behavioral Health Provider Responsibilities

Healthfirst expects Mental Health, Substance Use, and Home and Community Based Service (HCBS) providers to assume the following set of responsibilities:

  • Contact the Healthfirst Medical Management Department to verify member eligibility and to receive authorization for admissions and selected outpatient services as outlined in Appendix XI. The same authorization requirements will apply for all products. The authorization requirements are listed on the Healthfirst Provider Portal and at www.mctac.org
  • Maintain contact with the Healthfirst Medical Management Department as treatment progresses to receive continuing authorization for additional services.
  • Comply with the established policies and procedures of the Healthfirst Medical Management and Quality Improvement Programs
  • Adhere to recovery-oriented principles, including provision of person centered services
  • Coordinate with the Medical Management Department when necessary to ensure appropriate integration of services

Level of Care (LOC) covered for Medicaid Mainstream services and Health and Recovery Health Plan (HARP):

  • Inpatient - SUD and MH
  • Clinic – SUD and MH
  • Personalized Recovery Oriented Services (PROS)
  • Intensive Psychiatric Rehabilitation Treatment Program (IPRT)
  • Assertive Community Treatment (ACT)
  • Continuing Day Treatment
  • Partial Hospitalization
  • Comprehensive Psychiatric Emergency Program (CPEP)
  • Opioid Treatment Programs
  • Outpatient Chemical Dependence Rehabilitation
  • Rehabilitation Services for Residential SUD treatment support
  • Rehabilitation Supports for Community Residences
  • Buprenorphine prescribers
  • Ambulatory Detox
  • Inpatient and Outpatient ECT
  • Mobile Mental Health
  • Mobile Crisis Intervention
  • Home and Community Based Services (HCBS)*  
 
*Only HARP members will be eligible for HCBS pending an approved eligibility assessment.
 
Mental Health and Substance Use billing guidelines are available on the Healthfirst secure Provider Portal and in Appendix XV-D of Healthfirst Provider Manual.
Providers should refer to Section 9.4 "Utilization and Medical Management Guidelines" for additional guidance on Level of Care screening tools such as InterQual for Mental Health treatment and Locator 3.0 for Substance Use Disorder treatment.
 
Healthfirst Provider Portal is available www.healthfirst.org to all participating providers to verify member eligibility, view claims and authorization status.  Providers may contact Provider Services at 1-888-801-1660 for further assistance.