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Provider Alerts - Policy, Billing, or Coverage Update - 2025
Medicare Enrollment Guidelines for Medicaid Members with End Stage Renal Disease (ESRD)

The New York State Department of Health requires Medicaid members diagnosed with End Stage Renal Disease (ESRD) to apply for Medicare.

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Administration
Medicaid
Medicare
  
Provider Alerts - Education Events & Patient Care Resources - Practice Guidelines and Tips - 2025
Help Off-Exchange Members Renew Their Coverage

New York State will resume standard annual recertification procedures for off-exchange Medicaid, HARP, LIP, CC, and SHP members.

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Administration
Medicaid
Recertification
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
New Prior Authorization Requirements for CPT Codes Effective June 2025

Starting June 1, 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.

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Administration
Authorization
  
Provider Alerts - Claims & Billing - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2025
Personalized Recovery Oriented Services (PROS) Redesign

The New York State (NYS) Office of Mental Health (OMH) is redesigning the Personalized Recovery Oriented Services (PROS) program.

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Reimbursement
Medicaid
Administration
Behavioral Health and Mental Health
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Updated Coverage and Reimbursement for Adverse Childhood Experiences (ACEs) Screenings for Medicaid Members

Starting January 1, 2025, Adverse Childhood Experiences (ACEs) screenings conducted in primary settings has been expanded to cover one lifetime screening for Medicaid members who are between 21 to 65 years of age. Children and adolescents up to 21 years of age continue to receive coverage for annual ACEs screenings as appropriate and medically necessary.

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Administration
Medicaid
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prenatal and Postpartum Cost Sharing Reduction for Leaf Plan and Leaf Premier Plan Members

The New York State of Health (NYSOH) will cover the in-network cost-sharing for select prenatal and postpartum services for eligible members in our Leaf and Leaf Premier Plans

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Reimbursement
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2025
Submit Prior Authorization Requests Online through Availity Essentials™

Providers can access Healthfirst’s Online Authorization Tool through Availity Essentials. The Online Authorization Tool is a fast and efficient solution for submitting, tracking, and reviewing authorization requests.

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Administration
Authorization
  
Provider Alerts - General Update - 2025
Message A Payer Application Now Available on Availity Essentials

Providers can use the Message A Payer function to send secure messages directly to Healthfirst.

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Administration
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Updated Medicaid Billing Guidance for COVID-19 Vaccines

Due to the May 11, 2023, expiration of the Public Health Emergency for COVID-19, providers billing for COVID-19 should be aware of changes to the COVID-19 Vaccine and Administration as well as the Vaccines for Children Program .

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Administration
COVID-19
Vaccines
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization No Longer Required for Select Evicore Codes Starting April 1, 2025

Starting April 1, 2025, providers will no longer need to submit prior authorization requests to Evicore for select codes.

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Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Pediatric Vaccine Counseling Now Covered for Medicaid and Child Health Plus Members

Healthfirst will reimburse providers for pediatric vaccine counseling visits for Medicaid and Child Health Plus members under 21 years of age.

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Medicaid
Vaccines
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2020
Healthfirst Reimbursement Policy Updates - Effective March 1, 2020

Healthfirst Reimbursement Policy Updates

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Reimbursement
  
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