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Showing 13-24 of 774
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-068 Prenatal Screening (Nongenetic)

Prenatal screening encompasses any testing done to determine the health status of the pregnant individual and/or fetus.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-067 Evaluation of Dry Eyes

Dry eye disease (dysfunctional tear syndrome, DED) is defined by the Dry Eye Workshop II as “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-066 Prescription Medication and Illicit Drug Testing in the Outpatient Setting

Abuse of both prescription and illicit drugs is extremely common.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-065 Diagnosis of Idiopathic Environmental Intolerance

Idiopathic environmental intolerance (IEI), formerly called multiple chemical sensitivity (MCS), is a subjective condition characterized by recurrent, nonspecific symptoms attributed to low levels of chemical, biologic, or physical agents in the absence of consistent objective diagnostic physical findings or laboratory tests that define an illness.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-064 Immunopharmacologic Monitoring of Therapeutic Serum Antibodies

To manage loss of response due to the development of anti-drug antibodies, immunopharmacologic monitoring of circulating drug and anti-drug antibody levels has been proposed.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-063 General Inflammation Testing

Inflammatory response can occur due to tissue injury and/or various disorders, including arthritis, lupus, and infection.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-078 Telemedicine

This policy outlines the guidelines for telemedicine and telehealth services eligible for reimbursement by Healthfirst.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-132 Obstetric Billing Guidelines

This policy describes the reimbursement of obstetrical (OB) codes and the itemization of maternity care services.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-171 Clinical Research Studies (Clinical Trials)

This policy establishes reimbursement guidelines for services associated with member participation in clinical research studies (clinical trials), in accordance with applicable New York State Department of Health (NYS DOH), Centers for Medicare & Medicaid Services (CMS), and Affordable Care Act (ACA) requirements.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-061 Serum Biomarker Testing for Multiple Sclerosis and Related Neurological Diseases

Multiple sclerosis (MS) is the most common immune-mediated inflammatory demyelinating disease of the central nervous system (CNS) and is defined by multifocal areas of demyelination with loss of oligodendrocytes and astroglial scarring.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-060 Biomarker Testing for Autoimmune Rheumatic Disease

Systemic autoimmune rheumatic diseases (SARDs) are a diverse group of conditions that primarily affect the joints, bones, muscle, and connective tissue.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-059 Allergen Testing

Allergic disease is characterized by inappropriate or exaggerated rated immune reactions to foreign antigens (allergens) that are generally innocuous to most people, but when introduced into a genetically-predisposed individual, elicit a hypersensitivity reaction.

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Reimbursement Policy
  
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