Compliance, Regulatory & Policies

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

Reimbursement Policy: PO-RE-109 Vaccine Administration

Healthfirst acknowledges the importance of vaccination in promoting public health and aims to align its reimbursement policies with the Centers for Disease Control (CDC)/ Advisory Committee on Immunization Practices (ACIP), and other applicable New York State and local public health authorities, including New York State Department of Health (NYSDOH) and New York City Department of Health and Mental Hygiene (NYC DOHMH).

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-133 Therapeutic Drug Monitoring for 5-Fluorouracil

Chemotherapeutic agents are incredibly potent drugs, often carrying cytotoxic side effects.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-082 Testing of Homocysteine Metabolism-Related Conditions

Homocystinuria is a metabolic condition in which the body is unable to properly process certain amino acids, resulting in an abnormal accumulation of homocysteine and its metabolites in the blood and urine.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-065 Diagnosis of Idiopathic Environmental Intolerance

Idiopathic environmental intolerance (IEI), formerly called multiple chemical sensitivity (MCS), is a subjective condition characterized by recurrent, nonspecific symptoms attributed to low levels of chemical, biologic, or physical agents in the absence of consistent objective diagnostic physical findings or laboratory tests that define an illness.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-116 CPT Category III Codes

This policy applies to all healthcare providers submitting claims to Healthfirst for services that include CPT Category III codes.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-112 By Report

The By Report (BR) reimbursement policy outlines the guidelines for reimbursing Medicaid service codes that are designated “By Report” (“BR”) on the NYS Medicaid Physician Manual Fee Schedule and on the Ordered Ambulatory Fee Schedule.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-108 Transportation Services

The purpose of this policy is to define the reimbursement guidelines for transportation coverage provided by Healthfirst, including ancillary services and out-of-state emergency transportation services negotiation.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-068 Prenatal Screening (Nongenetic)

Prenatal screening encompasses any testing done to determine the health status of the pregnant individual and/or fetus.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-064 Immunopharmacologic Monitoring of Therapeutic Serum Antibodies

To manage loss of response due to the development of anti-drug antibodies, immunopharmacologic monitoring of circulating drug and anti-drug antibody levels has been proposed.

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Reimbursement Policy

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.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-015 Testing for Vector Borne Infections

Arthropod vectors, including mosquitoes, ticks, fleas, and mites, that feed on vertebrate hosts can spread bacteria, protozoa, and viruses during feeding to their susceptible host, resulting in a variety of infections and diseases.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025

Reimbursement Policy: PO-RE-158 Hospital Acquired Conditions (HAC)

Hospital Acquired Conditions (HACs) are serious conditions that develop during an inpatient hospital stay and are considered preventable when proper evidence-based procedures are followed.

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Reimbursement Policy

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Reimbursement Policy: PO-RE-109 Vaccine Administration

Reimbursement Policy: PO-RE-133 Therapeutic Drug Monitoring for 5-Fluorouracil

Reimbursement Policy: PO-RE-082 Testing of Homocysteine Metabolism-Related Conditions

Reimbursement Policy: PO-RE-065 Diagnosis of Idiopathic Environmental Intolerance

Reimbursement Policy: PO-RE-116 CPT Category III Codes

Reimbursement Policy: PO-RE-112 By Report

Reimbursement Policy: PO-RE-108 Transportation Services

Reimbursement Policy: PO-RE-068 Prenatal Screening (Nongenetic)

Reimbursement Policy: PO-RE-064 Immunopharmacologic Monitoring of Therapeutic Serum Antibodies

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

Reimbursement Policy: PO-RE-015 Testing for Vector Borne Infections

Reimbursement Policy: PO-RE-158 Hospital Acquired Conditions (HAC)

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-109 Vaccine Administration

Reimbursement Policy: PO-RE-133 Therapeutic Drug Monitoring for 5-Fluorouracil

Reimbursement Policy: PO-RE-082 Testing of Homocysteine Metabolism-Related Conditions

Reimbursement Policy: PO-RE-065 Diagnosis of Idiopathic Environmental Intolerance

Reimbursement Policy: PO-RE-116 CPT Category III Codes

Reimbursement Policy: PO-RE-112 By Report

Reimbursement Policy: PO-RE-108 Transportation Services

Reimbursement Policy: PO-RE-068 Prenatal Screening (Nongenetic)

Reimbursement Policy: PO-RE-064 Immunopharmacologic Monitoring of Therapeutic Serum Antibodies

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

Reimbursement Policy: PO-RE-015 Testing for Vector Borne Infections

Reimbursement Policy: PO-RE-158 Hospital Acquired Conditions (HAC)

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