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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
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Annual Wellness Visits, Initial Preventive Physical Examinations, and Problem Oriented Visit

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 distinguishing between Annual Wellness Visits (AWV), Initial Preventive Physical Examinations (IPPE), and Problem Oriented Visit.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Cerebral Palsy

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 Cerebral Palsy.

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Clinical Documentation Improvement
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Anorexia Nervosa and Bulimia Nervosa

This video offers guidance on proper clinical documentation and coding of Anorexia Nervosa and Bulimia Nervosa.

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Clinical Documentation Improvement
Video
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-128 Part B Custodial Services-Skilled Therapy and Vaccine Services

This policy outlines the guidelines for the reimbursement of Skilled Therapy and Vaccine services provided under Medicare Part B for custodial Healthfirst Medicare members.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-134 Prenatal and Postpartum Services Cost-Sharing Waiver

Starting January 1, 2025, a new NY State of Health (NYSOH) program under New York’s Section 1332 waiver will enhance access and affordability for pregnant and postpartum Qualified Health Plan (QHP) members.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-126 Diabetes Cost-sharing Waiver

This policy outlines Healthfirst’s reimbursement guidelines regarding the waiver of cost-sharing for Essential Plan (EP) and Qualified Health Plan (QHP) members diagnosed with Type 1, Type 2, or Gestational Diabetes.

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2026
Request a Continuous Glucose Monitoring Device for Healthfirst Medicare, Essential Plan, and Qualified Health Plan Members

Healthfirst members with Type 1 or Type 2 diabetes may qualify for a Continuous Glucose Monitoring (CGM) device if eligible. Available to Medicare, Essential Plan, and QHP members through an in-network DMEPOS provider, not a pharmacy.

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Administration
Healthfirst Plans
Authorization
Reimbursement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Aneurysm

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 an Aneurysm.

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Clinical Documentation Improvement
  
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