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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
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-046 Nerve Fiber Density Testing

Nerve fiber density testing involves analysis of skin biopsy stained with an antibody to antiprotein gene product 9.5 (Wilkinson et al., 1989) which avidly stains all axons (Dalsgaard et al., 1989).

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Reimbursement Policy
  
Provider Alerts - Practice Guidelines and Tips - 2025
Physician Order Documentation Process for Licensed Home Care Service Agencies

Licensed Home Care Service Agencies (LHCSA) are required to obtain and document a Physician’s Order before providing Personal Care Services and Private Duty Nursing to Senior Health Partner, CompleteCare, and Medicaid Members.

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Licensed Home Care Services Agencies
Administration
Medicaid
Medicare
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Additional Prior Authorization Codes Managed by EyeMed, Effective April 2025

Starting April 1, 2025, EyeMed will manage prior authorization for six new codes.

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Authorization
Dental and/or Vision
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective March 2025

Starting March 20, 2025, Healthfirst will add prior authorization requirements for selected medical services.

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Administration
Authorization
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2025
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective April 2025

Starting April 6, 2025, Healthfirst will add prior authorization requirements for selected medical 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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Administration
Authorization
  
Education Events & Patient Care Resources - Patient Resource - 2020
New York State Department of Health AIDS Institute Resource Directory
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Infectious Diseases
  
Documentation & Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Benign Carcinoid Tumors, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model Updates, on services submitted to Healthfirst—specifically for Benign Carcinoid Tumors.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Documentation & Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Cholangitis, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model updates, on services submitted to Healthfirst—specifically for common types of Cholangitis.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
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
  
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