Important Plan and Coverage Changes for 2025
These changes go into effect on Jan. 1, 2025
As part of the Inflation Reduction Act, changes are being instituted to help make healthcare more affordable. These changes could affect many of your patients.
Availity Essentials Update
Availity Essentials is Healthfirst's New Provider Portal
Access Healthfirst tools through Availity Essentials, our new provider portal designed to help make your work with us easier.
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What's New
View allPrior Authorization Guidelines for Select CPT and HCPCS Codes Effective March 2025
Starting March 20, 2025, Healthfirst will add prior authorization requirements for selected medical services. These changes are part of Healthfirst’s ongoing responsibility to evaluate its medical policies compared to the latest scientific evidence and specialty society guidance.
View postScheduling Configuration Changes for Linked and Mutual Visits
Starting January 1, 2025, Healthfirst is creating new service codes to accurately account for Linked and Mutual Visits provided to Medicaid, Personal Wellness Plans (HARP), Senior Health Partner (SHP) and CompleteCare (CC) members.
View postChanges to the Healthfirst Connection Plan (HMO D-SNP) and Life Improvement Plans Beginning in 2025
Starting January 1, 2025, Providers will need to bill Medicaid Fee-for-Service or Member’s Medicaid Coverage for Healthfirst Connection Plan Members’ cost sharing.
View postImportant Plan and Coverage Changes for 2025
As part of the Inflation Reduction Act, changes are being instituted to help make healthcare more affordable. These changes go into effect on January 1, 2025, and could affect many of your patients.
View postDiabetes Cost-Sharing Reduction for Essential Plan, Leaf Plan, and Leaf Premier Plan Members
Starting January 1, 2025, New York State of Health is implementing a Diabetes Cost-Sharing Reduction initiative to make services more accessible and affordable. Learn more about these cost-sharing reductions in this Provider Alert...
View postChanges to Claims Submissions for Prenatal and Postpartum Services
To understand the timing and delivery of perinatal services, the New York State Department of Health is requiring changes to claims submissions for perinatal services for Medicaid, Personal Wellness Plans (HARP), Medicaid Advantage Plans, and Connection Plan lines of business.
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