Compliance, Regulatory & Policies

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-019 Human Immunodeficiency Virus (HIV)

Human immunodeficiency virus (HIV) is an RNA retrovirus that infects human immune cells, specifically CD4 cells, causing progressive deterioration of the immune system ultimately leading to acquired immune deficiency syndrome (AIDS) characterized by susceptibility to opportunistic infections and HIV-related cancers

Open document

Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-018 Diagnosis of Vaginitis

Vaginitis is defined as inflammation of the vagina with symptoms of discharge, itching, and discomfort often due to a disruption of the vaginal microflora.

Open document

Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-014 Diagnostic Testing of Common Sexually Transmitted Infections

Sexually transmitted infections (STIs), often referred to as sexually transmitted diseases or STDs, include a variety of pathogenic bacteria, virus, and other microorganisms that are spread through sexual contact and can cause a multitude of complications if left untreated.

Open document

Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-011 Lyme Disease Testing

Lyme disease is a common multisystem inflammatory disease caused by spirochetes of the family Borreliaceae transmitted through the bite of an infected tick of the genus Ixodes.

Open document

Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-008 Venous and Arterial Thrombosis Risk Testing

A thrombosis, also known as a blood clot, occurs within blood vessels in the body.

Open document

Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-007 Intracellular Micronutrient Analysis

Micronutrients are dietary components, often referred to as vitamins and minerals, which although only required by the body in small amounts, are vital to development, disease prevention, and wellbeing.

Open document

Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-004 Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing

Parathyroid hormone (PTH), along with calcitriol and fibroblast growth factor 23 (FGF23), regulate calcium and phosphate homeostasis.

Open document

Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-003 Folate Testing

Folate, or vitamin B9, is a generic term for a water-soluble vitamin obtained from the diet that is involved in the transfer of methyl groups (i.e., single carbon-containing groups) in multiple biochemical metabolic pathways, including nucleic acid biosynthesis and methionine/homocysteine metabolism.

Open document

Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

Thyroid hormones are necessary for both prenatal and postnatal development, as well as metabolic activity in adults

Open document

Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-169 Medical Dental and Oral Health Coverage

Healthfirst recognizes that certain dental services are medically necessary and eligible for reimbursement when covered under a member’s medical benefit in accordance with Centers for Medicare & Medicaid Services (CMS) guidelines and applicable state and federal regulations.

Open document

Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

This policy outlines Healthfirst’s reimbursement methodology for additional office and outpatient services billed in conjunction with Evaluation and Management (E&M) services and other qualifying encounters, when performed on the same date of services for the same member by the same provider.

Open document

Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-110 Preventive Care Services (Commercial Plans)

Healthfirst recognizes the importances of preventive care in promoting overall health and well-being. To support our members in maintaining good health and preventing illnesses, we provide coverage for a range of preventive services in accordance with this policy.

Open document

Reimbursement Policy

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-019 Human Immunodeficiency Virus (HIV)

Reimbursement Policy: PO-RE-018 Diagnosis of Vaginitis

Reimbursement Policy: PO-RE-014 Diagnostic Testing of Common Sexually Transmitted Infections

Reimbursement Policy: PO-RE-011 Lyme Disease Testing

Reimbursement Policy: PO-RE-008 Venous and Arterial Thrombosis Risk Testing

Reimbursement Policy: PO-RE-007 Intracellular Micronutrient Analysis

Reimbursement Policy: PO-RE-004 Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing

Reimbursement Policy: PO-RE-003 Folate Testing

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

Reimbursement Policy: PO-RE-169 Medical Dental and Oral Health Coverage

Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

Reimbursement Policy: PO-RE-110 Preventive Care Services (Commercial Plans)

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-019 Human Immunodeficiency Virus (HIV)

Reimbursement Policy: PO-RE-018 Diagnosis of Vaginitis

Reimbursement Policy: PO-RE-014 Diagnostic Testing of Common Sexually Transmitted Infections

Reimbursement Policy: PO-RE-011 Lyme Disease Testing

Reimbursement Policy: PO-RE-008 Venous and Arterial Thrombosis Risk Testing

Reimbursement Policy: PO-RE-007 Intracellular Micronutrient Analysis

Reimbursement Policy: PO-RE-004 Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing

Reimbursement Policy: PO-RE-003 Folate Testing

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

Reimbursement Policy: PO-RE-169 Medical Dental and Oral Health Coverage

Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

Reimbursement Policy: PO-RE-110 Preventive Care Services (Commercial Plans)

You are now navigating away from the Healthfirst website.