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OUT-OF-NETWORK
REIMBURSEMENT RATES
Regulatory Updates

TOut-of-network providers who have been approved to render services to Healthfirst members will be reimbursed at the Healthfirst Standard Out-of-Network Fee Schedule applicable to the member’s Healthfirst plan

These fee schedules are established as a percentage of Medicaid or Medicare (depending upon the service and the member’s Healthfirst plan). These out-of-network fee schedules apply to the following plans

  • Healthfirst Essential Plan
  • Healthfirst Leaf and Leaf Premier Plans
  • Healthfirst Pro, Pro Plus, and Total Plan

In these instances, the Explanation of Payment will indicate “OON RATE: SEE HEALTHFIRST.ORG”.

Insights
November 2018