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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Prior Authorization No Longer Required for Select Codes Starting April 1, 2026

Effective April 1, 2026, Healthfirst will remove prior authorization requirements for several CPT codes currently managed by Integra.

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Administration
Healthfirst Plans
Authorization
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Essential Plan: What Providers Must Know about Newborn Enrollment

Healthfirst is reinforcing New York State Department of Health (NYSDOH) requirements regarding newborn coverage rules. This alert highlights the importance of timely newborn reporting, billing, and enrollment.

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

This policy outlines the reimbursement procedures for Vaccines for Children (VFC) at Healthfirst, ensuring compliance with New York State (NYS) Medicaid guidelines.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-160 Medicare Diabetes Prevention Program (MDPP)

The purpose of this policy is to establish compliant and consistent reimbursement and billing guidelines for the Medicare Diabetes Prevention Program (MDPP).

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Reimbursement Policy
  
Documentation & Coding - Policy, Billing, or Coverage Update - 2026
Medicare Physician and Practitioner Providers - Medical Record Request for Calendar Year 2024 (CY24) Part C Improper Payment Measure (Part C IPM)

This request is based on diagnosis data submitted to the Centers for Medicare & Medicaid Services (CMS) as a result of services you provided to MA beneficiaries during calendar year 2023 (CY23). The purpose of this request is to validate diagnoses that were sent to CMS to determine health status-adjusted payments under risk adjustment.

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Risk Adjustment Data Validation Audit
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-162 Diagnostic Laboratory

This policy outlines Healthfirst's standards and requirements for the reimbursement of diagnostic laboratory services.

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Reimbursement Policy
  
Plans & Benefits - Practice Guidelines and Tips - 2026
2026 Healthfirst Plans at a Glance

Healthfirst has health plans made for New Yorkers.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - 65 Plus Plan (HMO)

A Medicare Advantage plan with hospital, medical, and prescription drug coverage all in one plan

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - The Essential Plan

Federally subsidized plans for individuals who are ineligible for Medicaid due to income or immigration status.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Child Health Plus (CHPlus)

A New York State-sponsored health plan for individuals under the age of 19.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - CompleteCare (HMO D-SNP)

A Medicaid Advantage Plus plan that combines Medicare and Medicaid benefits with long-term care services.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Connection Plan (HMO D-SNP)

For those who are dual-eligible for both Medicare and cost-sharing assistance from Medicaid.

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Healthfirst Plans
  
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