Essential Plan 200-250 Coverage to End July 1, 2026
How You Can Prepare and Support Your Patients
The New York State Essential Plan coverage for individuals with incomes between 200% and 250% of the Federal Poverty Level will end effective July 1, 2026.
Medicare CAHPS Season Through May 31
Review the checklist for CAHPS success
Through May 31, a random sample of Healthfirst Medicare Plan members will receive the annual Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey.
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What's New
View allReminder: Non-Covered Codes for Medicaid Managed Care and Child Health Plus Reimbursement Policy Effective Feb. 1, 2026
Healthfirst is aligning with NYS Medicaid Billing Guidelines to ensure consistency in claims processing and reimbursement.
View postPrior Authorization Required for Select Codes Starting April 1, 2026
Effective April 1, 2026, Healthfirst will require prior authorization requirements for several CPT codes currently managed by Evicore.
View postPrior Authorization No Longer Required for Select Codes Starting April 1, 2026
Effective April 1, 2026, Healthfirst will remove prior authorization requirements for several CPT codes currently managed by Integra.
View postMedicare CAHPS Season is Here!
Here’s what you need to know about the annual Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey.
View postRequesting Copies of Provider 1099s and B Notice Inquiries
Where to submit your requests
View postPhysical Therapy Authorization and Approval Guidance Effective January 31, 2026
A provider questionnaire will now accompany initial prior authorization requests for Adult Physical Therapy across all Healthfirst plans to support efficient reviews and appropriate care decisions.
View postIntroducing Claim Pattern Review Program from Cotiviti
Effective August 1, 2026, Healthfirst will implement Cotiviti’s Claim Pattern Review Program to conduct ongoing reviews of specific professional claims.
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