Posted Jun 30, 2025
Beginning September 1, 2025, Healthfirst will implement concurrent review for Community Psychiatric Supports and Treatment (CPST) and Psychosocial Rehabilitation (PSR) services.
A printable PDF is available here.
After the first three visits, providers must submit the Children and Family Treatment Supports Service (CFTSS) Continuing Authorization Request Form along with the treatment plan to support continued medical necessity.
This document is intended to support understanding of service requirements, documentation expectations, and the concurrent review process for CPST and PSR as part of the Children Family Treatment and Support Services (CFTSS) array.
1. Will Healthfirst be conducting concurrent review on CFTSS?
Yes, but concurrent review of services will apply only to CPST and PSR services. At this time, no concurrent review is being performed for the other four CFTSS services (OLP, CI, FPSS, YPS).
2. Is Healthfirst requiring Concurrent Review for CPST and PSR?
Yes. Additionally providers are advised to indicate the first visit date of CPST and/or PSR on the CFTSS Continuing Authorization Request Form for notification purposes. Healthfirst will conduct concurrent reviews starting with the fourth visit.
3. What is the significance of the first service date on the concurrent review form?
The continuing authorization form includes a section where providers must indicate the date of the first CPST and/or PSR service to ensure the first three visits are recognized and prevent claims delays.
The initial service date is critical for aligning the review period with the service timeline. This date triggers the “first three visits” count. If the date is inaccurate or missing, it may cause billing or authorization mismatches.
4. How should providers submit concurrent review requests for PSR and CPST?
Submit the Children and Family Treatment Supports Service Continuing Authorization Request Form before the fourth visit for both PSR and CPST. Email completed forms to: CFTSSINFO@healthfirst.org.
5. What information is required on the Authorization Request Form?
The form must include:
6. What documentation is required?
To request services beyond the third visit, providers must submit:
7. What level of detail is expected regarding frequency and intensity of services?
To help reviewers assess appropriateness based on diagnosis, needs, and goals, providers must specify:
8. What is expected regarding the goals?
Goals should be:
9. Can CPST and/or PSR be denied for clinical reasons?
Yes. CPST and PSR are reviewed for medical necessity. It is imperative that you complete the CFTSS Authorization Form with all clinical information that allows our team to understand the need for services, progress on goals, and how any barriers to progress are being addressed. Each service is reviewed and a determination will be made. It is possible that the request is fully approved, partially approved or denied.
10. What happens if a partial approval is issued?
Based on medical necessity, Healthfirst may partially approve requested services. If a partial approval is issued, the decision will be communicated to the member and provider. Providers are responsible for tracking approved units and submitting follow-up requests as
needed.
In the event that requested services are not authorized or continued by Healthfirst, the Provider and/or Guardian may file a Plan Appeal. Additionally, you may request a Fair Hearing with Aid to Continue on behalf of the child/youth, and/or may request an external appeal.
11. How should claims be submitted?
Claims for PSR and CPST should be submitted in chronological order. Submitting claims out of sequence may lead to review misalignment, denied claims, and/or delayed payments.
12. What are common reasons for denied claims?
CFTSS claims, including CPST and PSR, may be denied due to administrative issues including:
13. How should providers approach the transition for members who are already receiving PSR and CPST?
Healthfirst has developed a transition process and related steps, which will be shared in upcoming training sessions and via email. In the meantime, providers should begin identifying members who are currently receiving services and who will continue those services after September 1, 2025, along with current frequency and duration. This information will ensure a smooth transition.
14. Will training be available?
Yes. Virtual webinars and 1:1 provider support will be available. Please contact your Network Account Manager to schedule or request additional assistance
Contact your Network Account Manager or reach out to Provider Services at 1-888-801-1660 Monday–Friday, 8:30am–5:30pm.
Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”).
Released July 2025
