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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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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
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
2025 Medicare Physician Fee Schedule Final Rule

Effective Jan 1, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the 2025 Medicare Physician Fee Schedule Final Rule with key updates impacting Preventive Services for Medicare members.

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Reimbursement
Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Changes to Prior Authorization Submissions for Back Pain Management and Spinal Surgery Services

Starting September 3, 2025, Healthfirst providers will need to submit prior authorizations via Optum’s Spine, Pain, and Joint portal as the OrthoNet portal will be discontinued.

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Reimbursement
Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization Requirements for Drugs, Supplies, and Procedures for Sexual Dysfunction or Erectile Dysfunction

In accordance with Chapter 645 of the Laws of 2005, the New York State (NYS) Medicaid program does not cover prescription or physician-administered drugs used for the treatment of sexual dysfunction (SD) or erectile dysfunction (ED).

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Reimbursement
Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization Guidelines for Select Remote Patient and Remote Therapeutic Monitoring Services

Prior Authorization Guidelines for Select Remote Patient (RPM) and Remote Therapeutic Monitoring (RTM) Services Effective September 1, 2025

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Reimbursement
Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Authorization Requirements for Additional Physical and Occupational Therapy Visits for New Conditions or Body Parts

Providers are reminded that when submitting an authorization request for an existing patient to treat a new condition or body part, the submission will be considered a new prior authorization request.

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Administration
Authorization
  
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