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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-075 Laboratory Procedures

To be considered for reimbursement, all outpatient laboratory claims should be submitted in accordance with: -AMA CPT and HCPCS coding and ICD-10 diagnosis coding guidelines -Other laboratory and pathology coding guidelines -All applicable regulatory guidelines

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-074 Remote Patient Monitoring and Remote Therapeutic Monitoring

The purpose of this policy is to outline the reimbursement guidelines for Remote Patient Monitoring (RPM) services and Remote Therapeutic Monitoring (RTM) services offered by Healthfirst.

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Reimbursement Policy
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Morbid Obesity

This video offers guidance on proper clinical documentation and coding of Morbid Obesity

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2025
Video - Documentation and Coding of Human Immunodeficiency Virus (HIV)

This video offers guidance on proper clinical documentation and coding of Human Immunodeficiency Virus (HIV)

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2025
Video - Documentation and Coding of Hepatitis C

This video offers guidance on proper clinical documentation and coding of Hepatitis C

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Chronic Obstructive Pulmonary Disease (COPD)

This video offers guidance on proper clinical documentation and coding of Chronic Obstructive Pulmonary Disease (COPD)

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Angina

This video offers guidance on proper clinical documentation and coding of Angina

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Clinical Documentation Improvement
Video
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2026
Interoperability and Prior Authorization Final Rule Requirements

Healthfirst is updating prior authorization and concurrent review decision timeframes to comply with the CMS Interoperability and Prior Authorization Final Rule. Effective January 1, 2026, standard authorization decisions for applicable Medicaid and Medicare lines of businesses.

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Administration
Healthfirst Plans
Medicaid
Medicare
  
Documentation & Coding - Practice Guidelines and Tips - 2026
Documentation and Coding: Bone Marrow Transplant (BMT)

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 Bone Marrow Transplant (BMT).

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Clinical Documentation Improvement
  
Provider Alerts - Behavioral Health and Foster Care - Practice Guidelines and Tips - 2026
Clinical Document Submission for Healthfirst Personal Wellness Plan

Frequently asked questions related to the submission of clinical documents by Behavioral Health providers for HARP/PWP members.

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Administration
Healthfirst Plans
Authorization
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-165 Outpatient Facility and Professional Claim Reimbursement – Lesser-of Methodology

This policy outlines Healthfirst’s standard reimbursement methodology for outpatient facilities and professional claims.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-094 Avoidable Readmission

Healthfirst's Avoidable Readmission reimbursement policy is designed to reduce avoidable readmissions and improve quality of care.

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Reimbursement Policy
  
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