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Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Life Improvement Plan (HMO D-SNP)

A Medicare Advantage special needs plan for individuals who are eligible for Medicare and Medicaid. Most Life Improvement Plan members have fee-for-service (FFS) Medicaid benefits administered by the New York State Department of Health.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Medicaid Managed Care

A New York State-sponsored Medicaid plan for low-income individuals, families, and children.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Personal Wellness Plan (PWP)

For Medicaid beneficiaries with serious mental health illness and/or substance use disorders.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Signature (HMO)

A Medicare Advantage plan for those looking for hospital, medical, and prescription drug coverage all in one plan with a flexible benefit card to help pay for member cost shares.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Signature (PPO)

A Medicare Advantage plan with the option to see out-of-network providers without a referral and/or prior authorization.

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Healthfirst Plans
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-116 CPT Category III Codes

This policy applies to all healthcare providers submitting claims to Healthfirst for services that include CPT Category III codes.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-112 By Report

The By Report (BR) reimbursement policy outlines the guidelines for reimbursing Medicaid service codes that are designated “By Report” (“BR”) on the NYS Medicaid Physician Manual Fee Schedule and on the Ordered Ambulatory Fee Schedule.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-108 Transportation Services

The purpose of this policy is to define the reimbursement guidelines for transportation coverage provided by Healthfirst, including ancillary services and out-of-state emergency transportation services negotiation.

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
CMS Cell and Gene Therapy (CGT) Access Model for Casgevy™ (exagamglogene autotemcel) and Lyfgenia® (lovotibeglogene)

Medicaid Practitioner Administered Drugs Update

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Administration
Healthfirst Plans
Medicaid
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst Member ID Cards

View Healthfirst Member ID Cards at a glance.

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Healthfirst Plans
  
Documentation & Coding - Video - 2026
Video - Status Codes Indicators

This video offers guidance on Status Codes Indicators

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Clinical Documentation Improvement
Video
  
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
  
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