Healthfirst for Providers

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

Reimbursement Policy: PO-RE-018 Diagnosis of Vaginitis

Vaginitis is defined as inflammation of the vagina with symptoms of discharge, itching, and discomfort often due to a disruption of the vaginal microflora. The most common infections are bacterial vaginosis, Candida vulvovaginitis, and trichomoniasis.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-016 β-Hemolytic Streptococcus Testing

Streptococcus are Gram-positive, catalase-negative bacteria that are further divided into α-hemolytic, such as S. pneumoniae and S. mutans; β-hemolytic, such as S. pyogenes (Group A), S. agalactiae (Group B), and S. dysgalactiae subsp equisimilis (Groups C and G); and γ-hemolytic, such as viridans group streptococci.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-015 Testing for Vector Borne Infections

Arthropod vectors, including mosquitoes, ticks, fleas, and mites, that feed on vertebrate hosts can spread bacteria, protozoa, and viruses during feeding to their susceptible host, resulting in a variety of infections and diseases.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-014 Diagnostic Testing of Common Sexually Transmitted Infections

Sexually transmitted infections (STIs), often referred to as sexually transmitted diseases or STDs, include a variety of pathogenic bacteria, virus, and other microorganisms that are spread through sexual contact and can cause a multitude of complications if left untreated.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-013 Urine Culture for Bacteria

Bacteriuria is the presence of bacteria in the urine. Urinary tract infections (UTIs) can occur in the urinary system and can be either symptomatic or asymptomatic

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-012 Pathogen Panel Testing

Infectious diseases can be caused by a wide range of pathogens. Conventional diagnostic methods like culture, microscopy with or without stains and immunofluorescence, and immunoassay often lack sensitivity and specificity and have long turnaround times.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-009 Diagnostic Testing of Influenza

Influenza is an acute respiratory illness caused by influenza A or B viruses resulting in upper and lower respiratory tract infection, fever, malaise, headache, and weakness.

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Reimbursement Policy

Pharmacy Resources & Formularies - Provider Resources - 2026

Prior Authorization Pharmacy Medical Benefit Grid

It is the policy of Healthfirst to require prior authorization for medical claims for all medications listed within this document. To learn more, including ways to submit prior authorization, access this resource.

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Authorization

Documentation & Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Chronic Post Rheumatic Arthropathy [Jaccoud]

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 Chronic Post Rheumatic Arthropathy [Jaccoud].

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Clinical Documentation Improvement

Documentation & Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Diabetes with Eye Complications

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 with Eye Complications.

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Clinical Documentation Improvement

Documentation & Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Discharge Summary

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 Discharge Summary.

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Clinical Documentation Improvement

Documentation & Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Major Head Injury

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 Major Head Injury.

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Clinical Documentation Improvement

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Reimbursement Policy: PO-RE-018 Diagnosis of Vaginitis

Reimbursement Policy: PO-RE-016 β-Hemolytic Streptococcus Testing

Reimbursement Policy: PO-RE-015 Testing for Vector Borne Infections

Reimbursement Policy: PO-RE-014 Diagnostic Testing of Common Sexually Transmitted Infections

Reimbursement Policy: PO-RE-013 Urine Culture for Bacteria

Reimbursement Policy: PO-RE-012 Pathogen Panel Testing

Reimbursement Policy: PO-RE-009 Diagnostic Testing of Influenza

Prior Authorization Pharmacy Medical Benefit Grid

Documentation and Coding: Chronic Post Rheumatic Arthropathy [Jaccoud]

Documentation and Coding: Diabetes with Eye Complications

Documentation and Coding: Discharge Summary

Documentation and Coding: Major Head Injury

Search

Resource Type

Filter

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Reimbursement Policy: PO-RE-018 Diagnosis of Vaginitis

Reimbursement Policy: PO-RE-016 β-Hemolytic Streptococcus Testing

Reimbursement Policy: PO-RE-015 Testing for Vector Borne Infections

Reimbursement Policy: PO-RE-014 Diagnostic Testing of Common Sexually Transmitted Infections

Reimbursement Policy: PO-RE-013 Urine Culture for Bacteria

Reimbursement Policy: PO-RE-012 Pathogen Panel Testing

Reimbursement Policy: PO-RE-009 Diagnostic Testing of Influenza

Prior Authorization Pharmacy Medical Benefit Grid

Documentation and Coding: Chronic Post Rheumatic Arthropathy [Jaccoud]

Documentation and Coding: Diabetes with Eye Complications

Documentation and Coding: Discharge Summary

Documentation and Coding: Major Head Injury

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