Pediatric Vaccine Counseling Now Covered for Medicaid and Personal Wellness Plan Members

As part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, Healthfirst will reimburse providers for pediatric vaccine counseling visits for Medicaid and Personal Wellness Plan (HARP) members under 21 years of age.

Join us in 2025! Provider Education Events

Our first webinar of the year is "Care to Coding: Guiding Pediatric Care Providers to Successful Coding for Billing, Risk, and Quality" on January 22.

Prior 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.

Scheduling 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.

Changes 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.

Important 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.

Diabetes 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...