HF Logo HF Logo
Provider Home / Claims & Billing
Resource Type
Clear All
Filter
Year
Sort By
Showing 1-12 of 87
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Additional Prior Authorization Codes Managed by EyeMed, Effective April 2025

Starting April 1, 2025, EyeMed will manage prior authorization for six new codes.

View Post
Authorization
Dental and/or Vision
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
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.

Open external link
Administration
Authorization
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2025
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective April 2025

Starting April 6, 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.

Open external link
Administration
Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
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.

View Post
Medicaid
Medicare
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Pediatric Vaccine Counseling Now Covered for Medicaid and Personal Wellness Plan Members

Healthfirst will reimburse providers for pediatric vaccine counseling visits for Medicaid and Personal Wellness Plan (HARP) members under 21 years of age.

View Post
Medicaid
Vaccines
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Changes to Claims Submissions for Prenatal and Postpartum Services

Providers using bundled or global procedure codes for billing perinatal services must submit non-payment category II CPT codes for members in Medicaid, Personal Wellness Plans, Medicaid Advantage Plans, and Connection Plans.

Open external link
Medicaid
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Prior Authorization No Longer Required for Antiretroviral Prescription Medications

Healthfirst has removed prior authorization requirements from all antiretroviral medications prescribed for the treatment or prevention of Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS) for all Healthfirst plans.

View Post
Authorization
Preventive Measures
Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Crisis Residence and Mobile Crisis Services Now Covered for Healthfirst Essential Plan, Leaf, and Leaf Premier Members

Starting January 1, 2025, Healthfirst will cover Crisis Residence Services and Mobile Crisis Services for our Essential Plan (EP) and Leaf and Leaf Premier Plan members (also known as our Qualified Health Plans). Additionally, these services will continue to be covered under the Medicaid, Personal Wellness Plans (HARP), Child Health Plus (CHPlus), and Medicaid Advantage Plan (MAP) lines of business.

Open external link
Medicaid
Behavioral Health and Mental Health
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Changes to OASAS Comprehensive Outpatient Treatment Programs and Updated Billing Guidance

The New York State Office of Addiction Service and Supports (OASAS) is implementing several changes to integrate care within the OASAS outpatient clinic regulatory structure, including a merged Comprehensive Outpatient Treatment Program (COP) operating certificate, COP reimbursement updates, and inclusion of Opioid Treatment Program (OTP) bundles into APG methodology.

Open external link
Behavioral Health and Mental Health
Reimbursement
Medicaid
Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Enhancing Claims Processing Accuracy with ClaimsXten

ClaimsXten (CXT) is an industry-leading claims editing software that adjudicates claims more efficiently and aligns with Healthfirst standards. Review the provider alert for more information on CXT, including updated frequently asked questions.

View Post
Administration
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2024
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective Jan. 1, 2025

Starting Jan. 1, 2025, Healthfirst will change its authorization guidelines for select CPT and HCPCS codes. See the Provider Alert for a list of codes that will now require prior authorization.

Open external link
Administration
Authorization
  
Claims & Billing - Form - 2024
Prior Authorization Request - Physical, Occupational, and Speech Therapies

Effective Jan. 1, 2024, Healthfirst has resumed responsibility for management of prior authorization (PA) requests for Physical, Occupational, and Speech Therapies. You may now submit PA requests for these services to Healthfirst for dates of service on or after Jan. 1, 2024. Please download this PDF of the fax request form or visit the Healthfirst Provider Portal at hfproviderportal.org to submit your request using our Online Authorization tool.

Open document
Prior Authorization
  
You are now navigating away from the Healthfirst website.

Links to non-Healthfirst websites are provided for your convenience only. Healthfirst is not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.