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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
  
Education Events & Patient Care Resources - Video - 2025
Provider Education Events - Recorded Video Sessions

Browse our previously recorded webinars and training sessions.

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Provider Events
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-134 Prenatal and Postpartum Services Cost-Sharing Waiver

Starting January 1, 2025, a new NY State of Health (NYSOH) program under New York’s Section 1332 waiver will enhance access and affordability for pregnant and postpartum Qualified Health Plan (QHP) members.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-132 Obstetric Billing Guidelines

This policy describes the reimbursement of global obstetrical (OB) codes and the itemization of maternity care services. Maternity care encompasses prenatal, delivery, antepartum, and postpartum care.

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
New Prior Authorization Requirements for CPT Codes Effective June 2025

Starting June 1, 2025, Healthfirst will add prior authorization requirements for selected medical 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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Administration
Authorization
  
Provider Alerts - Claims & Billing - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2025
Personalized Recovery Oriented Services (PROS) Redesign

The New York State (NYS) Office of Mental Health (OMH) is redesigning the Personalized Recovery Oriented Services (PROS) program.

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Reimbursement
Medicaid
Administration
Behavioral Health and Mental Health
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-113 Doula Services

Effective January 1, 2025, Healthfirst will provide coverage of Doula Services provided in accordance with 42 CFR section 440.130(c). This policy outlines Healthfirst guidelines for the reimbursement of Doula Services.

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Updated Coverage and Reimbursement for Adverse Childhood Experiences (ACEs) Screenings for Medicaid Members

Starting January 1, 2025, Adverse Childhood Experiences (ACEs) screenings conducted in primary settings has been expanded to cover one lifetime screening for Medicaid members who are between 21 to 65 years of age. Children and adolescents up to 21 years of age continue to receive coverage for annual ACEs screenings as appropriate and medically necessary.

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Administration
Medicaid
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prenatal and Postpartum Cost Sharing Reduction for Leaf Plan and Leaf Premier Plan Members

The New York State of Health (NYSOH) will cover the in-network cost-sharing for select prenatal and postpartum services for eligible members in our Leaf and Leaf Premier Plans

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Reimbursement
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2025
Submit Prior Authorization Requests Online through Availity Essentials™

Providers can access Healthfirst’s Online Authorization Tool through Availity Essentials. The Online Authorization Tool is a fast and efficient solution for submitting, tracking, and reviewing authorization requests.

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Administration
Authorization
  
Provider Alerts - General Update - 2025
Message A Payer Application Now Available on Availity Essentials

Providers can use the Message A Payer function to send secure messages directly to Healthfirst.

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Administration
  
Quality Program Resources - Education Events & Patient Care Resources - Plans & Benefits - Practice Guidelines and Tips - 2025
2025 Special Needs Plan Model of Care Provider Training

This presentation will help educate providers, delegated vendors, and appropriate staff on the Healthfirst Special Needs Plan (SNP) Model of Care (MOC), the goal of which is to enhance member health outcomes through the use of an integrated care delivery system.

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Administration
  
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