Wiki Healthfirst global delivery

[klapetri@ilovemygyn.com]

2/28/2025- Healthfirst is denying some claims when billed 59400/59510
most are paid and recently we are receiving denials.
we investigated healthfirst policy and clicked on link that advised,
Does anyone have guidance on this

Submission of Prenatal and Postpartum Service Claims for Each Pregnancy Related Visit​

To better understand the timing and delivery of perinatal (prenatal and postpartum) services to New York State (NYS) Medicaid members and Medicaid Managed Care (MMC) enrollees, additional information is needed from NYS Medicaid providers. Effective for service delivered as of July 1, 2024 , providers using bundled/global procedure codes for billing will also be required to submit claims with non-payment Category II Current Procedural Terminology (CPT) codes for perinatal services to NYS Medicaid fee-for-service (FFS) and MMC. The bundled/global bill procedure codes are "59400" , "59410" , "59510" , "59515" , "59610" , "59614" , "59618" , "59622" , "59426" and "59425" .

Effective July 1, 2024 , providers are required to submit a claim with a Category II CPT code for each prenatal/postpartum service provided to a NYS Medicaid member when the provider is billing using the global bill codes or a bundled bill. These Category II CPT code claims are in addition to the global or bundled code claims. Claims for NYS Medicaid FFS members must be submitted directly to NYS Medicaid. Claims for MMC enrollees must be submitted to the MMC Plan of the enrollee. Additionally, the following Category II CPT codes must be used:

CPT Code	Code Description
0500F	INITIAL PRENATAL VISIT
0502F	SUBSEQUENT PRENATAL VISIT
0503F	POSTPARTUM VISIT

 

[csperoni]

NY Medicaid and Managed Medicaid now want submission of statistical codes 0500F-0503F when billing a maternity code that includes more than delivery only. I'm assuming the practice already enters these codes at each encounter, with zero fee and are not submitted to insurance. You now simply need to have them generate a claim to the carrier(s) requiring it. You may need assistance from your EHR vendor to set this up if you don't know how to do so on your own.
It's not only HealthFirst. Medicaid made it effective 07/01/2024. From what I have seen the Managed Medicaids are rolling it out a bit delayed.
Emblem https://www.emblemhealth.com/providers/news/billing-prenatal-visits-medicaid-202411

 

[klapetri@ilovemygyn.com]

thanks for the info.!

 

[klapetri@ilovemygyn.com]

Update!
So we are receiving denials from Healthfirst and Emblem Health HIP Medicaid.
When calling on denied claims, representatives from HIP are now manually entering the claims.
denial codes-Missing/incomplete/invalid other procedure code(s)
N61 Rebill services on separate claims

16	CLAIM LACKS INFO OR HAS SUBMISSION/BILLING ERROR
Remark	C2	BILL VISITS/DELIVERY SEPARATELY

 

[bgrasson]

IS THIS ONLY FOR BILLING GLOBALLY? NOT FEE FOR SERVICE

 

[csperoni]

IS THIS ONLY FOR BILLING GLOBALLY? NOT FEE FOR SERVICE

Fee for service has not changed - submit each service individually with appropriate CPT.
This is currently for NYS FFS Medicaid, and managed Medicaids are rolling out as well.
When billing for maternity care using codes that are not delivery only (whether antepartum, global delivery, or delivery with postpartum), the payor must also receive the reporting Category II codes 0500F-0503F. I believe this is creating havoc at the payor level as well, which may be the reason for receiving so many denials. What used to be one claim to submit, process, and pay now becomes a dozen to submit and process, then link to another claim to pay.

 

[klapetri@ilovemygyn.com]

This is causing major issues, all HF and HIP claims deny. Even our HF representative can't explain why claims are denied and not processed and paid since we are following the guidelines.

 

[bgrasson]

Fee for service has not changed - submit each service individually with appropriate CPT.
This is currently for NYS FFS Medicaid, and managed Medicaids are rolling out as well.
When billing for maternity care using codes that are not delivery only (whether antepartum, global delivery, or delivery with postpartum), the payor must also receive the reporting Category II codes 0500F-0503F. I believe this is creating havoc at the payor level as well, which may be the reason for receiving so many denials. What used to be one claim to submit, process, and pay now becomes a dozen to submit and process, then link to another claim to pay.

We only bill globally for one carrier- the rest are FFS, so you're telling all of those FFS prenatal claims need the F codes? or we can do F code on one prenatal, F code on the delivery, and then F code on the postpartum? sorry I'm a little confused lol.

 

[veritable17]

what date of service do we apply for the add on codes? 0050F, 0502F and 0503F? thank you.

 

[klapetri@ilovemygyn.com]

0050F-initial prenatal visit- 1 unit
0502F -date range how many prenatal from-to(1/1/2025-5/15/2025) units = how many visits
0503F-dos is date of delivery 1 unit

 

[csperoni]

We only bill globally for one carrier- the rest are FFS, so you're telling all of those FFS prenatal claims need the F codes? or we can do F code on one prenatal, F code on the delivery, and then F code on the postpartum? sorry I'm a little confused lol.

This policy is specifically for NYS Medicaid and Managed Medicaid when billing maternity codes other than delivery only. The original post lists the codes.
Here is the official NYS Medicaid FFS policy: https://health.ny.gov/health_care/medicaid/program/update/2024/no06_2024-06.htm
If your payor contracts are to bill individually already, then this policy update would not apply.