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Provider Forms - Form - 2026
Provider Prior Authorization Request Fax

Use this form when requesting prior authorization and/or providing supporting clinical documentation.

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Authorization
Forms
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Manufacturers Withdrawing from the Medicaid Drug Rebate Program (MDRP)

Effective January 1, 2026, several drug manufacturers have voluntarily withdrawn from participation in the Medicaid Drug Rebate Program (MDRP). In accordance with federal requirements, NYRx will no longer provide Medicaid coverage for drugs manufactured by the companies listed in this provider alert.

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Administration
Healthfirst Plans
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Pulmonary Embolism

This video offers guidance on proper clinical documentation and coding of Pulmonary Embolism.

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of General Cancer

This video offers guidance on proper clinical documentation and coding of General Cancer.

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Clinical Documentation Improvement
Video
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-164 Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor

Effective January 1, 2026, Healthfirst will cover Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) under Current Procedural Terminology (CPT) code 61715.

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Changes to Prior Authorization Submissions for Back Pain Management and Spinal Surgery Services

Starting June 1, 2026, 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 - 2026
Integra Partners to Manage Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Prior Authorization Requests Effective June 1, 2026

Effective June 1, 2026, Integra Partners will manage prior authorization (Utilization Management) for all Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) on behalf of Healthfirst for all plans.

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Administration
Authorization
Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Prior Authorization Required for Select Codes Starting April 1, 2026

Effective April 1, 2026, Healthfirst will require prior authorization requirements for several CPT codes currently managed by Evicore.

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Administration
Healthfirst Plans
Authorization
Reimbursement
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Breast Cancer

This video offers guidance on proper clinical documentation and coding of Breast Cancer.

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2024
Video - Documentation and Coding of Peripheral Vascular Disease

This 5-minute video offers guidance on proper clinical documentation and coding of peripheral vascular disease.

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2024
Video - Documentation and Coding of Cerebral Infarction

This short video offers guidance on proper clinical documentation and coding of cerebral infarction.

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2024
Video - Documentation and Coding of Prostate Cancer

This 5-minute video offers guidance on proper clinical documentation and coding of prostate cancer

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Clinical Documentation Improvement
Video
  
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