NY Manual
SHP Manual

New York Provider Manual
1.2 About Healthfirst, Inc. | 2.1 Healthfirst PHSP Programs

1.3 Network Management and Provider Services

Network Management

All participating hospitals, their affiliated providers and individual participating providers have a designated Healthfirst representative who serves as the liaison between the facility, its affiliated providers, participating providers, and Healthfirst. These representatives provide information, problem-solve, and respond as needed to provider concerns. 

Provider Services

Healthfirst also has a dedicated phone unit available to assist providers with questions regarding Healthfirst policies and procedures, member care, reimbursement, claim information or general information about Healthfirst and its products. If you have any questions or need more information about Healthfirst and its products, please contact Provider Services at 1-888-801-1660, Monday–Friday, 9am–5:00pm

Healthfirst Secure Provider Portal

Hospitals, providers, and their office staff can access information 24 hours a day, 7 days a week on the Healthfirst secure Provider Portal at www.healthfirst.org/providers. Quick and easy online registration to the Provider Portal provides access to tools that enable you to:

·     Verify member eligibility
·     Submit appeals, corrected claims and view claim status
·     View the status of authorizations
·     Submit questions to Healthfirst
·     Request access to online reports and member enrollment rosters
·     Submit files/documents to Healthfirst
·     Request demographic information update
·     Access Healthfirst policies and procedures
·     Review the latest clinical guidelines, newsletters, reference materials, and more

For more information about our web site, send an e-mail to webmaster@healthfirst.org, and to register for access visit www.healthfirst.org/providers and click New Users – Sign Up Here

Other Healthfirst Departments

In addition to Provider Services, there are other departments at Healthfirst that you may contact or work with on a regular basis. The following table highlights these areas and outlines their key functions. Healthfirst staff members from these departments are available to assist you in providing care to Healthfirst members.

 

Department
Key Functions and Responsibilities
 
Provider Services
P.O. Box 5168
New York, NY 10274-5168
1-888-801-1660
Monday-Friday, 9:00 a.m. – 5:00 p.m.
 
<   Provider Services Inquiries
 
Provider Claim Appeals
P.O. Box 958438
Lake Mary, FL 32795-8438
1-888-801-1660
Monday - Friday from 9:00 a.m. – 5:00 p.m.
 
<   Member Appeals and Grievances
<   Claims Appeals and Grievances
Claims
P.O. Box 958438
Lake Mary, FL 32795-8438
1-888-801-1660
Monday - Friday from 9:00 a.m. – 5:00 p.m.
eclaims@healthfirst.org
<   Claims Payment and Status Inquiries
<   Claim Review and Reconsideration
 
Medical Management & Behavioral Health Unit
P.O. Box 5166
New York, NY 10274-5166
Phone: 1-888-394-4327
Fax: 1-646-313-4603
Monday - Friday from 8:30 a.m. - 5:30 p.m.
 
<   Transitional Care
<   Care Management and Disease Management
<   Assistance in Finding Appropriate Specialists
<   Utilization Review
<   Authorizations for Initial and Continuing Care
 
Member Services
P.O. Box 5165
New York, NY 10274
Medicaid / CHP / FHP
1-866-463-6743
Monday-Friday, 8:00 a.m. – 6:00 p.m.
(English, Spanish, Mandarin, Cantonese, Russian)
Medicare/Commercial: 1-888-260-1010
(TTY 1-888-542-3821
for the hearing/speech impaired)
Monday - Friday from 8:00 a.m. – 8:00 p.m.
Healthfirst Leaf Plans:
1-888-250-2220 (Option 1)
English TTY: 1-888-542-3821
Spanish TTY: 1-888-867-4132
Monday - Friday from 8:00 a.m. – 8:00 p.m.
Small Group and Healthy NY:
1-888-260-1010 (Option 4)
Monday - Friday from 8:00 a.m. – 8:00 p.m.
(English, Spanish, Mandarin, Cantonese)
 
<   Eligibility Verification
<   Member Benefits
<   Distribution of Member Handbooks
<  Distribution of Provider Directories to Members
<   New Member Orientations
<   PCP Selection
Clinical Performance Management Department
P.O. Box 5163
New York, NY 10274-5163
<   Quality of Care Investigations
<   HEDIS and QARR
<   Quality Incentive Programs
<   Quality Improvement Committees
<   Quality Improvement Studies
<   Member Satisfaction Surveys
<   Public Health Reporting
<   Preventive Health and Clinical Practice Guidelines
<   Medical Record Documentation Audits
<   Risk Adjustment and Payment System
<   Credentialing
 
Confidential Compliance Contact
To report compliance concerns in addition to suspected fraud, waste and abuse, anonymously call
1-877-879-9137
or go to