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Education Events & Patient Care Resources - Provider Resources - 2025
Provider Education Events

See our calendar of provider education events and register today.

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Provider Events
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-143 Somatosensory Evoked Potentials/Responses (SEPs/SERs)

This reimbursement policy outlines the guidelines for the coverage and reimbursement of Somatosensory Evoked Potentials (SEPs) and Somatosensory Evoked Responses (SERs) as per the Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination (LCD) L34975 and Local Coverage Article A56773 for Jurisdictions H and L.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-136 Brainstem Auditory Evoked Potentials and Responses (BAEPs/BAERs)

This policy outlines the reimbursement guidelines for Brainstem Auditory Evoked Potentials (BAEPs) and Brainstem Auditory Evoked Responses (BAERs) testing, in accordance with Local Coverage Determination (LCD) L34975 and Local Coverage Article A56773, Jurisdiction H and L.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-129 Medicare Physician Fee Schedule Status Indicators

The purpose of this reimbursement policy is to define the payment criteria for covered services as designated by the Centers for Medicare and Medicaid Services (CMS), particularly those classified as "always bundled" when billed alongside another physician's procedure or service.

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Reimbursement Policy
  
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
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2025
OIG Targeted High Risk Condition Series Session 1

OIG Targeted High Risk Condition Series Session 1: Heart Failure, Chronic Kidney Disease (CKD), Hypertension (HTN) (February 6, 2025)

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2025
OIG Targeted High Risk Condition Series, Session 2

OIG Targeted High Risk Condition Series, Session 2: Heart Failure, AFIB, Angina - Part 2 (March 6, 2025)

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2025
OIG Targeted High Risk Condition Series, Session 3

Book for OIG Targeted High Risk Condition Series, Session 3: Major Depression Disorder, Anorexia & Bulimia (April 3, 2025)

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2025
OIG Targeted High Risk Condition Series, Session 4

Book for OIG Targeted High Risk Condition Series, Session 4: Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT), Hepatitis & Cirrhosis (May 1, 2025)

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Provider Events
  
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