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Provider Forms - Form - 2025
New York Independent Assessor Program (NYIAP) Assessment Request Form

Providers and Medicaid health plan members must complete this form if the provider believes that the member requires non-covered community based long-term services and supports and would be a candidate for a Managed Long-Term Care (MLTC) plan.

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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization No Longer Required for Select EviCore Codes Starting January 1, 2026

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

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Administration
Healthfirst Plans
Authorization
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization Requirements for Select Services Starting January 1, 2026

CPT codes, newly released by the Centers for Medicare & Medicaid Services (CMS) and effective January 1, 2026, will include prior authorization requirements.

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Administration
Healthfirst Plans
Authorization
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization Requirements for Select Services Starting April 1, 2026

Effective April 1, 2026, Healthfirst will add prior authorization requirements for select medical services for Medicare Plans only.

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Administration
Healthfirst Plans
Medicare
Reimbursement
  
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
  
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
Over-the-Counter (OTC) Plus Card Changes for 2026

Starting January 1, 2026, Healthfirst members enrolled in our Life Improvement Plan (HMO D-SNP) and Connection Plan (HMO D-SNP) will need to qualify for Special Supplemental Benefit for the Chronically Ill (SSBCI) to use their OTC Plus Card for healthy food and home utilities.

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Administration
Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Reimbursement Update for Child Abuse Pediatrics Services

Effective December 1, 2025, in alignment with the New York State Department of Health, Healthfirst Medicaid will begin reimbursing physicians certified by the American Board of Pediatrics in Child Abuse Pediatrics a once-per-New York State Medicaid member lifetime fee for services related to the diagnosis, treatment, or supervision of care in cases of suspected child maltreatment.

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Administration
Healthfirst Plans
Medicaid
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Updated Telehealth Modifier Use

Updates to the billing requirements for telehealth services delivered through New York State Office of Mental Health (OMH)

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Reimbursement
Healthfirst Plans
Administration
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
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 - 2025
Reimbursement Policy: PO-RE-107 Point of Care Ultrasound (PoCUS)

This document describes the policy Healthfirst follows for Point of Care Ultrasound (PoCUS). This policy is executed pursuant to applicable provisions set forth in the contracts for the products indicated above, Articles 44 and 49 of the New York State (NYS) Public Health Law (PBH), as well as applicable Federal and State statutes and regulations.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-158 Hospital Acquired Conditions (HAC)

Hospital Acquired Conditions (HACs) are serious conditions that develop during an inpatient hospital stay and are considered preventable when proper evidence-based procedures are followed.

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Reimbursement Policy
  
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