NY Manual
SHP Manual

New York Provider Manual
15.18 External Review – Commercial, CHPlus | 16.2 Primary Care Services/Primary Care Providers

16. Provider Compensation 

Billing and reimbursement policies serve as a supplement to the Provider Compensation section of the Provider Manual. Please refer to Appendix XIV-A for a complete list of coding requirements.

16.1 Payees

As detailed in Section 3.1 of this manual, Healthfirst contracts with providers through participating hospitals (Level I providers) or directly with individual providers or provider groups (Level II and Level III providers). For all Level I providers who are covered by the hospital agreement with Healthfirst and who practice in hospital outpatient departments or hospital-owned community-based sites, payment is made directly to the hospital. Level II and Level III providers and provider groups receive payment from Healthfirst directly.