New 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.
New Tools in Availity Essentials
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 allUpdated Coverage and Reimbursement for Adverse Childhood Experiences (ACEs) Screenings for Medicaid Members
ACEs screenings conducted in primary settings has been expanded to cover one lifetime screening for Medicaid members between 21 to 65 years of age. Children and adolescents up to 21 years of age continue to receive coverage for annual ACEs screenings as appropriate and medically necessary.
View postPrior Authorization No Longer Required for Select Evicore Codes Starting April 2025
Providers will no longer need to submit prior authorization requests to Evicore for select codes.
View postPhysician Order Documentation Process for Licensed Home Care Service Agencies
Licensed Home Care Service Agencies are required to obtain and document a physician order before providing personal care services and private duty nursing to Senior Health Partner, CompleteCare, and Medicaid Members.
View postProvider Education Events - new event registration links added
Check out our calendar and sign up for an event today.
View postReminder Regarding Diabetic Testing Supplies
Ascenia/Bayer (Contour and Contour Next) products
View postNew Prior Authorization Requirements for CPT Codes Effective April 2025
Starting April 6, 2025, Healthfirst will add prior authorization requirements for selected medical services.
View postEyeMed to Manage Prior Authorization for Six New Codes Starting April 2025
EyeMed manages Healthfirst’s prior authorization for surgical and therapeutic vision services as well as network management, related member and provider service calls, and claims payment for routine vision and medical optometry services.
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