Compliance, Regulatory & Policies

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

Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Home Sleep Tests (HSTs) are designed to help diagnose sleep disordered breathing conditions in a home-setting.

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Healthfirst administers reimbursement for Vaccines for Children (VFC) services in accordance with applicable federal and New York State (NYS) laws, regulations, Medicaid requirements, and VFC program guidance, including requirements issued by the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), the New York State Department of Health (NYSDOH), and other applicable federal or state authorities.

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Effective May 1st, 2025, Healthfirst implemented a new reimbursement policy for Psychological-Neuropsychological testing.

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-140 Electromyography and Nerve Conduction Studies

This policy outlines the guidelines for reimbursing Electromyography (EMG) and Nerve Conduction Studies (NCS) performed to diagnose, evaluate, or manage peripheral nerve and neuromuscular disorders.

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

This reimbursement policy describes Healthfirst's reimbursement requirements for Certified Community Behavioral Health Clinic (CCBHC) services provided to eligible Healthfirst members.

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 Evaluation and Management (E&M) services and additional office and outpatient services billed on the same date of service.

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-109 Vaccine Administration

This policy establishes Healthfirst's reimbursement guidelines for vaccine administration services.

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

Colorectal cancer (CRC) is the term used to describe the development of cancer in the colon or the rectum.

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-067 Evaluation of Dry Eyes

Dry eye disease (dysfunctional tear syndrome, DED) is defined by the Dry Eye Workshop II as “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-066 Prescription Medication and Illicit Drug Testing in the Outpatient Setting

Abuse of both prescription and illicit drugs is extremely common.

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-060 Biomarker Testing for Autoimmune Rheumatic Disease

Systemic autoimmune rheumatic diseases (SARDs) are a diverse group of conditions that primarily affect the joints, bones, muscle, and connective tissue.

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-059 Allergen Testing

Allergic disease is characterized by inappropriate or exaggerated rated immune reactions to foreign antigens (allergens) that are generally innocuous to most people, but when introduced into a genetically-predisposed individual, elicit a hypersensitivity reaction.

Open document

Reimbursement Policy

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Reimbursement Policy: PO-RE-140 Electromyography and Nerve Conduction Studies

Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

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

Reimbursement Policy: PO-RE-109 Vaccine Administration

Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

Reimbursement Policy: PO-RE-067 Evaluation of Dry Eyes

Reimbursement Policy: PO-RE-066 Prescription Medication and Illicit Drug Testing in the Outpatient Setting

Reimbursement Policy: PO-RE-060 Biomarker Testing for Autoimmune Rheumatic Disease

Reimbursement Policy: PO-RE-059 Allergen Testing

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Reimbursement Policy: PO-RE-140 Electromyography and Nerve Conduction Studies

Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

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

Reimbursement Policy: PO-RE-109 Vaccine Administration

Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

Reimbursement Policy: PO-RE-067 Evaluation of Dry Eyes

Reimbursement Policy: PO-RE-066 Prescription Medication and Illicit Drug Testing in the Outpatient Setting

Reimbursement Policy: PO-RE-060 Biomarker Testing for Autoimmune Rheumatic Disease

Reimbursement Policy: PO-RE-059 Allergen Testing

You are now navigating away from the Healthfirst website.