Healthfirst for Providers

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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

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

Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026

Important Update to Electronic Remittance Advice (ERA) Distribution Logic

Healthfirst is updating the logic used to route ERA transactions.

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Administration

Reimbursement

Education Events & Patient Care Resources - Video - 2026

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 - 2026

Reimbursement Policy: PO-RE-172 Multiple Procedure Reduction

Healthfirst applies multiple procedure payment reductions when multiple surgical or procedural services are performed during the same operative session for the same member.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Home Sleep Tests (HSTs) are designed to help diagnose sleep disordered breathing conditions in a home-setting.

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Reimbursement Policy

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

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Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

Important Update to Electronic Remittance Advice (ERA) Distribution Logic

Provider Education Events - Recorded Video Sessions

Reimbursement Policy: PO-RE-172 Multiple Procedure Reduction

Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Reimbursement Policy: PO-RE-140 Electromyography and Nerve Conduction Studies

Documentation and Coding: Nursing Home Documentation Recommendations

Managing Member Concerns and Grievances

Cotiviti Claim Pattern Review Program

Search

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

Important Update to Electronic Remittance Advice (ERA) Distribution Logic

Provider Education Events - Recorded Video Sessions

Reimbursement Policy: PO-RE-172 Multiple Procedure Reduction

Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Reimbursement Policy: PO-RE-140 Electromyography and Nerve Conduction Studies

Documentation and Coding: Nursing Home Documentation Recommendations

Managing Member Concerns and Grievances

Cotiviti Claim Pattern Review Program

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