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Have questions about
claims or our network?


Our automated phone system is available:
24 hours a day 7 days a week

Live Phone Representatives are available:
Monday-Friday,
9:00 am to 5:00 pm
1-888-801-1660

New York Claims Submission Address:
P.O Box 958438
Lake Mary, FL 32795

New York Request for Review and Reconsideration:
P.O Box 958438
Lake Mary, FL 32795

Electronic Payor ID: 80141

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Compliance

Healthfirst promotes a culture of compliance and is committed to maintaining an ethical work environment for all our employees. Our commitment to compliance is supported by our confidential compliance hotline and website, which are completely anonymous and accessible 24 hours a day, 7 days a week, 365 days a year. We encourage employees, members, FDRs (First Tier, Downstream, and Related Entities), providers and vendors to report suspected cases of fraud, waste, abuse, or other violations of company policy in whatever manner they feel most comfortable. We have also established company-wide policies to promote a compliant workplace, such as non-retaliation, internal investigation, self-reporting, and more.

If you suspect a case of fraud, waste, abuse, or other violations of company policy, you can report it by:

  • Calling the toll-free Confidential Compliance Hotline at 1-877-879-9137
  • Filing a report via the Confidential Website Address: www.hfcompliance.ethicspoint.com

Healthfirst recognizes the importance of compliance. We want to ensure we – and you – practice within the law and are compliant with all privacy and best practice regulations.

Healthfirst’s commitment to compliance includes ensuring that our First Tier, Downstream and Related Entities (FDRs) and Affiliates are in compliance with applicable state and federal regulations.  Healthfirst contracts with FDRs and Affiliates to provide administrative or healthcare services to our enrollees; we are ultimately responsible for fulfilling the terms and conditions with our contract with the Center for Medicare & Medicaid Services (CMS) and meeting the Medicare and Medicaid program requirements. Therefore, Healthfirst has developed a process to validate that each contracted entity has met the requirements.  

Every FDR and Affiliate (including hospital systems, providers, and vendors) must complete an electronic FDR and Affiliate Compliance Attestation by March 15, 2014 and annually thereafter.

Please visit our website at www.healthfirstFDR.org to review the FDR and Affiliate Compliance Guide, which includes the FDR and Affiliate compliance requirements, and to complete the FDR Compliance Attestation.

HIPAA Advisory: Sharing Member Information with Healthfirst
Healthfirst regularly requests member medical records and other clinical information from its providers. Some providers were concerned that releasing this information to our plan without written consent from members would violate the Health Insurance Portability and Accountability Act (HIPAA).

Rest assured…it’s permitted. Click here to find out why.


Compliance Documents
Looking for the most current compliance information? Please download the documents below.

Guide to the Compliance Program PDF icon image
  FDR and Affiliate Compliance Guide PDF icon image
    Managed Care Reform Bill PDF icon image

 

Last update 2014-07-07 08:59