The You First fee schedule is in accordance with Centers for Disease Control and Prevention (CDC) guidelines. All fees are based on the average Medicare Part B rate. Providers agree to write-off any remaining balance related to You First covered procedures and not bill the member (this is counted as “match” for the You First Program). The CDC mandates that the You First Program has match 1:3, which equals one dollar for every three dollars of federal funds.
You First is able to pay for cardiovascular disease risk-factor screening for members over the age of 40, which includes yearly screening and a diagnostic follow-up (if needed). The screening visit must include two blood pressure results, height, weight, a blood glucose test, and a cholesterol test (either in the office or at a lab).
The breast and cervical component of You First will pay for exam screenings as well as breast and cervical-related diagnostic visits necessary to make a diagnosis.
You First members should identify themselves at check in. Their eligibility can be checked with the Eligibility Verification System (EVS). For screening and diagnostic aid category "LF", for treatment aid category "BG" or "BH".
Denied and Suspended Claims
You First remittance advices (RA) are posted weekly in the portal for provider look-up. You First claims that are denied, suspended for review or paid are reported on the RA. You First RAs are integrated into all of your Healthcare Program RAs. If you need assistance in understanding the reason for your claim denial, please call the You First billing specialist.
Call 800-508-2222 to speak with our billing specialist.