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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Reimbursement Update for Child Abuse Pediatrics Services

Effective December 1, 2025, in alignment with the New York State Department of Health, Healthfirst Medicaid will begin reimbursing physicians certified by the American Board of Pediatrics in Child Abuse Pediatrics a once-per-New York State Medicaid member lifetime fee for services related to the diagnosis, treatment, or supervision of care in cases of suspected child maltreatment.

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Administration
Healthfirst Plans
Medicaid
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Updated Telehealth Modifier Use

Updates to the billing requirements for telehealth services delivered through New York State Office of Mental Health (OMH)

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Reimbursement
Healthfirst Plans
Administration
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-158 Hospital Acquired Conditions (HAC)

Hospital Acquired Conditions (HACs) are serious conditions that develop during an inpatient hospital stay and are considered preventable when proper evidence-based procedures are followed.

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Reimbursement Policy
  
Documentation & Coding - Video - 2025
Video - Risk Adjustment 101

This video focuses on Risk Adjustment 101.

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Clinical Documentation Improvement
Video
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Update on NYS Medicaid Coverage for Therapeutic Transcranial Magnetic Stimulation (TMS)

Effective November 1, 2025, Healthfirst will provide coverage for Therapeutic Transcranial Magnetic Stimulation (TMS) for eligible Medicaid, Medicaid Advantage Plus (MAP), and Health and Recovery Plan (HARP) members diagnosed with Treatment-Resistant Major Depressive Disorder (MDD)..

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Administration
Healthfirst Plans
Medicaid
Reimbursement
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-156 Non-Covered Codes – Medicaid Managed Care and Child Health Plus

This policy outlines the reimbursement guidelines for non-covered CPT® and HCPCS codes billed to Healthfirst for Medicaid Managed Care and Child Health Plus.

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Reimbursement Policy
  
Provider Alerts - Pharmacy Resources & Formularies - Practice Guidelines and Tips - 2025
Obtaining Physician-Administered Drugs through a Specialty Pharmacy

As a Healthfirst provider, you can get Physician-Administered Drugs (PADs) delivered to your office at no cost through White Bagging when the medication is obtained from a Healthfirst in-network specialty pharmacy provider.

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Pharmacy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-155 Non-Covered Codes – Medicare

This policy outlines the reimbursement approach for non-covered Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes submitted by providers participating in Healthfirst Medicare Advantage (MA) plans.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-102 Taxonomy

A taxonomy code is a unique 10-character alphanumeric code that signifies a provider’s classification and area of specialization.

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Reimbursement Policy
  
Provider Alerts - Policy, Billing, or Coverage Update - 2025
Prior Authorization Guidelines for Select Services Effective February 1, 2026

Starting February 1, 2026, Healthfirst will add prior authorization requirements for selected vision services. These changes are part of Healthfirst’s ongoing responsibility to evaluate its medical policies compared to the latest scientific evidence and specialty society guidance.

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Authorization
  
Provider Alerts - Pharmacy Resources & Formularies - Policy, Billing, or Coverage Update - 2025
Reimbursement Update for Contrast Agents Prescribed to Medicaid Members

To align with the New York State Medicaid Pharmacy Program policies, Healthfirst will no longer reimburse any contrast agents used for radiological testing for members enrolled in Medicaid Managed Care (MMC) or Personal Wellness Plans (HARP).

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Pharmacy
Medicaid
  
Provider Forms - Form - 2025
Provider Attestation for OTC Plus Special Supplemental Benefits

Submit this form so your patient can use their OTC benefits for food and utilities.

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Forms
  
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