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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Important Prior Authorization Changes effective October 1, 2025

Healthfirst will remove prior authorization requirements for selected medical services effective October 1, 2025

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Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Important Prior Authorization Changes effective December 1, 2025

Healthfirst will add prior authorization requirements for selected medical services effective December 1, 2025

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Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Policy, Billing, or Coverage Update - 2025
Outpatient PT and Physical Therapy Continuation Request Requirements

Healthfirst will require specific clinical documentation for all Outpatient Physical Therapy continuation requests

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Healthfirst Plans
Administration
  
Provider Alerts - Practice Guidelines and Tips - 2025
2025 Annual Compliance Requirements - Mandatory Training and Certification

Required Mandatory Annual Compliance Training

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Healthfirst Plans
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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Changes To Opioid Treatment Program (OTP) Bundle Rate Billing Requirements Effective November 3, 2025

Updated Billing Requirements to Opioid Treatment Program (OTP)

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Reimbursement
Medicaid
Administration
  
Provider Alerts - Compliance, Regulatory & Policies - Practice Guidelines and Tips - 2025
Important Notice Regarding U.S. Department of Justice Regulations on Sensitive Personal Data

The United States Department of Justice (DOJ) has issued new regulations titled the “Final Rule on Preventing Access to U.S. Sensitive Personal Data and United States Government-Related Data by Countries of Concern”, codified at 28 C.F.R. Part 202.

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Healthfirst Plans
Administration
  
Provider Alerts - Practice Guidelines and Tips - 2025
2025 Medicare Diabetes Prevention Program (MDPP) Expanded Model Updates

Effective Jan 1, 2025, The Centers for Medicare & Medicaid Services (CMS) finalized several updates to the Medicare Diabetes Prevention Program (MDPP).

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Reimbursement
Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Updated Telehealth Modifier Use

Updates to the billing requirements for telehealth services delivered through New York State Office of Mental Health (OMH)

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Reimbursement
Healthfirst Plans
Administration
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Electronic Consultation (eConsult) Reimbursement

Reimbursement Updates for eConsults

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Administration
Reimbursement
Healthfirst Plans
  
Provider Alerts - Practice Guidelines and Tips - 2025
Concurrent Review Updates for Select Child and Family Treatment and Support Services (CFTSS)

Effective September 1, 2025, Healthfirst will implement Concurrent review for Psychosocial Rehabilitation (PSR) and Community Psychiatric Supports and Treatment (CPST) services under the Children and Family Treatment and Support Services (CFTSS) benefit.

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Reimbursement
Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Practice Guidelines and Tips - 2025
FAQ for Concurrent Review Updates for Select Child and Family Treatment and Support Services (CFTSS)

Answers to frequently asked questions (FAQs) regarding Healthfirst implementation of concurrent review for Psychosocial Rehabilitation (PSR) and Community Psychiatric Supports and Treatment (CPST) services under the Children and Family Treatment and Support Services (CFTSS) benefit, effective September 1, 2025.

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Reimbursement
Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Pharmacy Resources & Formularies - Claims & Billing - Policy, Billing, or Coverage Update - 2025
New Physician Dispenser Policy

New York State Department of Health has requested that Healthfirst notify practitioners of this change and inform them that they will need to bill claims through the Medical benefit after September 1, 2022, to be reimbursed.

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Administration
  
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