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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025

Updated Medicaid Billing Guidance for COVID-19 Vaccines

Due to the May 11, 2023, expiration of the Public Health Emergency for COVID-19, providers billing for COVID-19 should be aware of changes to the COVID-19 Vaccine and Administration as well as the Vaccines for Children Program .

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Administration

COVID-19

Vaccines

Reimbursement

Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025

Prior Authorization No Longer Required for Select Evicore Codes Starting April 1, 2025

Starting April 1, 2025, providers will no longer need to submit prior authorization requests to Evicore for select codes.

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Authorization

Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024

Pediatric Vaccine Counseling Now Covered for Medicaid and Child Health Plus Members

Healthfirst will reimburse providers for pediatric vaccine counseling visits for Medicaid and Child Health Plus members under 21 years of age.

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Medicaid

Vaccines

Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2020

Healthfirst Reimbursement Policy Updates - Effective March 1, 2020

Healthfirst Reimbursement Policy Updates

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Reimbursement

Plans & Benefits - Practice Guidelines and Tips - 2025

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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At a Glance

Plans & Benefits - Practice Guidelines and Tips - 2025

Healthfirst at a Glance - CompleteCare (HMO D-SNP)

A Medicaid Advantage Plus plan that combines Medicare and Medicaid benefits with long-term care services.

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At a Glance

Plans & Benefits - Practice Guidelines and Tips - 2025

Healthfirst at a Glance - Connection Plan (HMO D-SNP)

A Medicare Advantage dual-eligible special needs plan that coordinates coverage for those who are enrolled in a Medicaid plan or have Fee-for-Service Medicaid benefits administered by the New York State Department of Health (NYSDOH).

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At a Glance

Plans & Benefits - Practice Guidelines and Tips - 2025

Healthfirst at a Glance - Increased Benefits Plan (HMO)

A Medicare Advantage plan for eligible Medicare beneficiaries who qualify for the Qualifying Individual (QI) Program, which helps people with Medicare pay fewer drug costs

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At a Glance

Plans & Benefits - Practice Guidelines and Tips - 2025

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 FFS Medicaid benefits administered by the New York State Department of Health.

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At a Glance

Plans & Benefits - Practice Guidelines and Tips - 2025

Healthfirst at a Glance - Signature (HMO)

A Medicare Advantage plan that allows members to select only the benefits they need. The plan is designed for individuals who don’t qualify for programs that help pay Medicare costs, like Extra Help or Medicaid.

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At a Glance

Plans & Benefits - Practice Guidelines and Tips - 2025

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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At a Glance

Pharmacy Resources & Formularies - Provider Resources - 2025

Prior Authorization Pharmacy Medical Benefit Grid

It is the policy of Healthfirst to require prior authorization for medical claims for all medications listed within this document. To learn more, including ways to submit prior authorization, access this resource.

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Authorization