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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Changes to Prior Authorization Submissions for Back Pain Management and Spinal Surgery Services

Starting June 1, 2026, Healthfirst providers will need to submit prior authorizations via Optum’s Spine, Pain, and Joint portal as the OrthoNet portal will be discontinued.

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Reimbursement
Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Integra Partners to Manage Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Prior Authorization Requests Effective June 1, 2026

Effective June 1, 2026, Integra Partners will manage prior authorization (Utilization Management) for all Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) on behalf of Healthfirst for all plans.

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Administration
Authorization
Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Prior Authorization Required for Select Codes Starting April 1, 2026

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

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Administration
Healthfirst Plans
Authorization
Reimbursement
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Breast Cancer

This video offers guidance on proper clinical documentation and coding of Breast Cancer.

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2024
Video - Documentation and Coding of Peripheral Vascular Disease

This 5-minute video offers guidance on proper clinical documentation and coding of peripheral vascular disease.

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2024
Video - Documentation and Coding of Cerebral Infarction

This short video offers guidance on proper clinical documentation and coding of cerebral infarction.

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Clinical Documentation Improvement
Video
  
Documentation & Coding - Video - 2024
Video - Documentation and Coding of Prostate Cancer

This 5-minute video offers guidance on proper clinical documentation and coding of prostate cancer

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Clinical Documentation Improvement
Video
  
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
  
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
  
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
  
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