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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Healthfirst administers reimbursement for Vaccines for Children (VFC) services in accordance with applicable federal and New York State (NYS) laws, regulations, Medicaid requirements, and VFC program guidance, including requirements issued by the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), the New York State Department of Health (NYSDOH), and other applicable federal or state authorities.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Effective May 1st, 2025, Healthfirst implemented a new reimbursement policy for Psychological-Neuropsychological testing.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-140 Electromyography and Nerve Conduction Studies

This policy outlines the guidelines for reimbursing Electromyography (EMG) and Nerve Conduction Studies (NCS) performed to diagnose, evaluate, or manage peripheral nerve and neuromuscular disorders.

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Reimbursement Policy
  
Documentation & Coding - Practice Guidelines and Tips - 2026
Documentation and Coding: Nursing Home Documentation Recommendations

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 Nursing Home Documentation.

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Clinical Documentation Improvement
  
Provider Alerts - Practice Guidelines and Tips - 2026
Managing Member Concerns and Grievances

These FAQs serve as a resource to help practices identify and address member concerns and dissatisfaction. Along with enhancing the quality of care and service delivery to foster a positive member experience and reduce the occurrence of complaints and grievances.

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Administration
Healthfirst Plans
  
Provider Alerts - Practice Guidelines and Tips - 2026
Cotiviti Claim Pattern Review Program

Starting August 1, 2026, Healthfirst will implement Cotiviti’s Claim Pattern Review (CPR) Program to conduct ongoing reviews of specific professional claims.

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Administration
Healthfirst Plans
Reimbursement
  
Provider Alerts - Practice Guidelines and Tips - 2026
Managing Shared Services in Households with Multiple Members

Effective April 6, 2026, Healthfirst may designate a portion of authorized Personal Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS) hours as shared services when two or more members live in the same household.

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Administration
Healthfirst Plans
Medicare
Medicaid
  
Provider Alerts - Practice Guidelines and Tips - 2026
Access to Care and Appointment Availability Audits

This FAQ helps providers understand Access to Care and Appointment Availability (ACAA) standards and prepare for compliance audits.

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Administration
Healthfirst Plans
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

This reimbursement policy describes Healthfirst's reimbursement requirements for Certified Community Behavioral Health Clinic (CCBHC) services provided to eligible Healthfirst members.

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Reimbursement Policy
  
Documentation & Coding - Practice Guidelines and Tips - 2026
Documentation and Coding: Non-Pressure Ulcer

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 Non-Pressure Ulcer.

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Clinical Documentation Improvement
  
Provider Alerts - Claims & Billing - Coronavirus (COVID-19) - Policy, Billing, or Coverage Update - 2021
COVID-19 Testing — Billing Guidance

Healthfirst will cover medically appropriate COVID-19 testing at no cost share during the public health emergency when such testing is ordered by a physician or licensed healthcare professional for the purpose of diagnosis or treatment of COVID-19.

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COVID-19
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

This policy outlines Healthfirst's reimbursement methodology for Evaluation and Management (E&M) services and additional office and outpatient services billed on the same date of service.

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Reimbursement Policy
  
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