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Pharmacy Resources & Formularies - Provider Resources - 2026
Prior Authorization Pharmacy Medical Benefit Grid

It is the policy of Healthfirst to require prior authorization for medical claims for all medications listed within this document. To learn more, including ways to submit prior authorization, access this resource.

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Authorization
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Aneurysm

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for an Aneurysm.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Annual Wellness Visits, Initial Preventive Physical Examinations, and Problem Oriented Visit

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for distinguishing between Annual Wellness Visits (AWV), Initial Preventive Physical Examinations (IPPE), and Problem Oriented Visit.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Cerebral Palsy

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for Cerebral Palsy.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Chronic Post Rheumatic Arthropathy [Jaccoud]

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst— specifically for common types of Chronic Post Rheumatic Arthropathy [Jaccoud].

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Diabetes with Eye Complications

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for Diabetes with Eye Complications.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Discharge Summary

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for Discharge Summary.

Open document
Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Major Head Injury

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, on services submitted to Healthfirst—specifically for Major Head Injury.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Malignant Melanoma of Face

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, on services submitted to Healthfirst—specifically for Malignant Melanoma of Face.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Multiple Sclerosis

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for common types of multiple sclerosis (MS).

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Osteomyelitis

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for Osteomyelitis.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Personality Disorders

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for Personality Disorders.

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Clinical Documentation Improvement
  
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