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Provider Alerts - Policy, Billing, or Coverage Update - 2025

Prior Authorization Guidelines for Select Services Effective February 1, 2026

Starting February 1, 2026, Healthfirst will add prior authorization requirements for selected vision 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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Authorization

Provider Alerts - Pharmacy Resources & Formularies - Policy, Billing, or Coverage Update - 2025

Reimbursement Update for Contrast Agents Prescribed to Medicaid Members

To align with the New York State Medicaid Pharmacy Program policies, Healthfirst will no longer reimburse any contrast agents used for radiological testing for members enrolled in Medicaid Managed Care (MMC) or Personal Wellness Plans (HARP).

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Pharmacy

Medicaid

Provider Forms - Form - 2025

Provider Attestation for OTC Plus Special Supplemental Benefits

Submit this form so your patient can use their OTC benefits for food and utilities.

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Forms

Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Diabetes Mellitus

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 Mellitus.

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Clinical Documentation Improvement

Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Pulmonary Fibrosis

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 Pulmonary Fibrosis.

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Clinical Documentation Improvement

Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Chronic Obstructive Pulmonary Disease

This tip sheet is intended to assist providers and coding staff with the documentation and on services submitted to Healthfirst—specifically for Chronic Obstructive Pulmonary Disease (COPD).

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Clinical Documentation Improvement

Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Breast Cancer

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 breast cancer.

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Clinical Documentation Improvement

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025

Reimbursement Policy: PO-RE-150 Cardiac Event Detection - External Mobile Telemetry

This reimbursement policy outlines the guidelines for Mobile Cardiac Telemetry (MCT), a critical service for monitoring cardiac activity in patients with suspected or paroxysmal dysrhythmias.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025

Reimbursement Policy: PO-RE-078 Telemedicine

This policy outlines the guidelines for telemedicine and telehealth services eligible for reimbursement by Healthfirst.

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Reimbursement Policy

Provider Forms - Form - 2025

Podiatry and Peripheral Vascular Disease Prior Authorization Request

Use this form when requesting prior authorization of Podiatry and Peripheral Vascular Disease services for Healthfirst members

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Forms

Provider Forms - Form - 2025

Outpatient Physical Therapy, Occupational Therapy, and Speech Therapy Prior Authorization Request

Use this form when requesting prior authorization of physical, occupational, or speech therapy services for Healthfirst members.

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Forms

Provider Forms - Form - 2025

Children and Family Treatment Support Services (CFTSS) Continuing Authorization Request Form

Healthfirst is requesting concurrent review at the fourth visit for Community Psychiatric Supports & Treatment (CPST) and Psychosocial Rehabilitation (PSR). The CFTSS provider should complete this form when requesting continuation of services and submit the current CFTSS Treatment Plan, if available.

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Forms

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Prior Authorization Guidelines for Select Services Effective February 1, 2026

Reimbursement Update for Contrast Agents Prescribed to Medicaid Members

Provider Attestation for OTC Plus Special Supplemental Benefits

Documentation and Coding: Diabetes Mellitus

Documentation and Coding: Pulmonary Fibrosis

Documentation and Coding: Chronic Obstructive Pulmonary Disease

Documentation and Coding: Breast Cancer

Reimbursement Policy: PO-RE-150 Cardiac Event Detection - External Mobile Telemetry

Reimbursement Policy: PO-RE-078 Telemedicine

Podiatry and Peripheral Vascular Disease Prior Authorization Request

Outpatient Physical Therapy, Occupational Therapy, and Speech Therapy Prior Authorization Request

Children and Family Treatment Support Services (CFTSS) Continuing Authorization Request Form

Search

Resource Type

Filter

Year

Sort By

Prior Authorization Guidelines for Select Services Effective February 1, 2026

Reimbursement Update for Contrast Agents Prescribed to Medicaid Members

Provider Attestation for OTC Plus Special Supplemental Benefits

Documentation and Coding: Diabetes Mellitus

Documentation and Coding: Pulmonary Fibrosis

Documentation and Coding: Chronic Obstructive Pulmonary Disease

Documentation and Coding: Breast Cancer

Reimbursement Policy: PO-RE-150 Cardiac Event Detection - External Mobile Telemetry

Reimbursement Policy: PO-RE-078 Telemedicine

Podiatry and Peripheral Vascular Disease Prior Authorization Request

Outpatient Physical Therapy, Occupational Therapy, and Speech Therapy Prior Authorization Request

Children and Family Treatment Support Services (CFTSS) Continuing Authorization Request Form

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