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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-027 Cardiovascular Disease Risk Assessment

Cardiovascular risk assessment comprises the means and processes to predict the probability of developing a cardiovascular disease.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-012 Pathogen Panel Testing

Infectious diseases can be caused by a wide range of pathogens. Conventional diagnostic methods like culture, microscopy with or without stains and immunofluorescence, and immunoassay often lack sensitivity and specificity and have long turnaround times.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-003 Folate Testing

Folate, or vitamin B9, is a generic term for a water-soluble vitamin obtained from the diet that is involved in the transfer of methyl groups (i.e., single carbon-containing groups) in multiple biochemical metabolic pathways, including nucleic acid biosynthesis and methionine/homocysteine metabolism.

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Important Prior Authorization Changes effective October 1, 2025

Healthfirst will remove prior authorization requirements for selected medical services effective October 1, 2025

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Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Important Prior Authorization Changes effective December 1, 2025

Healthfirst will add prior authorization requirements for selected medical services effective December 1, 2025

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Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Policy, Billing, or Coverage Update - 2025
Outpatient PT and Physical Therapy Continuation Request Requirements

Healthfirst will require specific clinical documentation for all Outpatient Physical Therapy continuation requests

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Healthfirst Plans
Administration
  
Education Events & Patient Care Resources - Video - 2025
Provider Education Events - Recorded Video Sessions

Browse our previously recorded webinars and training sessions.

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Provider Events
  
Coding - Video - 2025
Video - 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
  
Provider Alerts - Practice Guidelines and Tips - 2025
2025 Annual Compliance Requirements - Mandatory Training and Certification

Required Mandatory Annual Compliance Training

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Healthfirst Plans
Administration
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-140 Electromyography and Nerve Conduction Studies

This policy outlines the guidelines for reimbursing Electromyography (EMG) and Nerve Conduction Studies (NCS) performed to diagnose, evaluate, or manage peripheral nerve and neuromuscular disorders.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-147 Skin Substitute Grafts and Cellular or Tissue based Products (CTPs)

This policy outlines reimbursement guidelines for the application of skin substitute graft and cellular and or tissue-based products (CTPs) used in the treatment of acute and chronic wounds, including but not limited to diabetic foot ulcers, venous leg ulcers, burns, breast reconstruction and surgical wounds.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-146 Chronic Disease Self-Management Program (CDSMP) for Arthritis

This policy establishes the guidelines and requirements for the reimbursement of evidence-based Chronic Disease Self-Management Program (CDSMP) services for Arthritis provided to eligible Healthfirst members aged 18 years and older.

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Reimbursement Policy
  
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