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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Reimbursement Update for Child Abuse Pediatrics Services

Effective December 1, 2025, in alignment with the New York State Department of Health, Healthfirst Medicaid will begin reimbursing physicians certified by the American Board of Pediatrics in Child Abuse Pediatrics a once-per-New York State Medicaid member lifetime fee for services related to the diagnosis, treatment, or supervision of care in cases of suspected child maltreatment.

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Administration
Healthfirst Plans
Medicaid
Reimbursement
  
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
Update on NYS Medicaid Coverage for Therapeutic Transcranial Magnetic Stimulation (TMS)

Effective November 1, 2025, Healthfirst will provide coverage for Therapeutic Transcranial Magnetic Stimulation (TMS) for eligible Medicaid, Medicaid Advantage Plus (MAP), and Health and Recovery Plan (HARP) members diagnosed with Treatment-Resistant Major Depressive Disorder (MDD)..

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Administration
Healthfirst Plans
Medicaid
Reimbursement
  
Provider Alerts - Pharmacy Resources & Formularies - Practice Guidelines and Tips - 2025
Obtaining Physician-Administered Drugs through a Specialty Pharmacy

As a Healthfirst provider, you can get Physician-Administered Drugs (PADs) delivered to your office at no cost through White Bagging when the medication is obtained from a Healthfirst in-network specialty pharmacy provider.

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Pharmacy
  
Provider Alerts - Policy, Billing, or Coverage Update - 2025
Prior Authorization Guidelines for Select Services Effective February 1, 2026

Starting February 1, 2026, Healthfirst will add prior authorization requirements for selected vision 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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Authorization
  
Provider Alerts - Pharmacy Resources & Formularies - Policy, Billing, or Coverage Update - 2025
Reimbursement Update for Contrast Agents Prescribed to Medicaid Members

To align with the New York State Medicaid Pharmacy Program policies, Healthfirst will no longer reimburse any contrast agents used for radiological testing for members enrolled in Medicaid Managed Care (MMC) or Personal Wellness Plans (HARP).

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Pharmacy
Medicaid
  
Provider Alerts - Practice Guidelines and Tips - 2025
Expanded Intimate Partner Violence Screening Guidelines for Women

Effective 12/24/2025, the USPSTF reaffirmed its Grade B recommendation to screen women of reproductive age, including pregnant and postpartum, for Intimate Partner Violence (IPV), reinforcing the importance of early detection.

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Administration
Preventive Measures
  
Provider Alerts - General Update - 2025
Important Update Regarding NewYork-Presbyterian and Healthfirst

Healthfirst’s highest priority is ensuring our members have access to the quality care they need.

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Administration
  
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
Administration
  
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