NY Manual
SHP Manual

New York Provider Manual
9.4 Utilization and Medical Management Guidelines | 10.2 Laboratory

10. Ancillary and Other Special Services

10.1 Overview of Services and the Provider Network

Healthfirst has arrangements in place to provide a full range of ancillary and other special services to its members, depending on the program in which they are enrolled. These services include:

·     Adult and Social Day Care
·     Ambulatory Surgery Center
·     Audiology and Hearing Services 
·     Cardiac Monitoring
·     Community Care Management (AIDS Institute–defined)
·     Chiropractic Services (Medicare and Commercial)
·     Dental Care
·     Diagnostic Imaging Services
·     Dialysis
·     Durable Medical Equipment (DME)
·     Home Healthcare and Home Infusion Therapy
·     Hospice
·     Laboratory Services
·     Mental Health
·     Orthotics and Prosthetics
·     Outpatient Rehabilitation
·     Personal Care Services
·     Physical/Occupational/Speech Therapy
·     Routine Vision Care
·     Nursing Home and Custodial Care
·     Substance Use Disorders
·     Transportation 

This section of the Provider Manual describes the scope of services and network arrangements in place for selected ancillary and special services covered by Healthfirst. Please refer to Appendix XI for additional instructions on referral and prior authorization guidelines for Ancillary Services. 

Ancillary Services Provider Responsibilities

Healthfirst expects participating ancillary service providers to adhere to the following service guidelines:

When ordering services for a member, identify the member as a Healthfirst member and provide the member’s Healthfirst ID number as well as his or her own Healthfirst provider ID number.

Promptly report all findings, clinical reports, test results, and recommendations to the PCP and/or ordering provider in writing, by mail or fax.

Consult the Healthfirst Medical Management staff to obtain required authorization for services.

Collaborate with the member’s PCP and Medical Management staff to ensure continuity of care and appropriate integration of services.