Healthfirst for Providers

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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

Documentation & Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Diabetes Mellitus

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for Diabetes Mellitus.

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Clinical Documentation Improvement

Documentation & Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Pulmonary Fibrosis

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst —specifically for common types of Pulmonary Fibrosis.

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Clinical Documentation Improvement

Documentation & Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Chronic Obstructive Pulmonary Disease

This tip sheet is intended to assist providers and coding staff with the documentation and on services submitted to Healthfirst—specifically for Chronic Obstructive Pulmonary Disease (COPD).

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Clinical Documentation Improvement

Documentation & Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Breast Cancer

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst —specifically for breast cancer.

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Clinical Documentation Improvement

Provider Forms - Form - 2025

Podiatry and Peripheral Vascular Disease Prior Authorization Request

Use this form when requesting prior authorization of Podiatry and Peripheral Vascular Disease services for Healthfirst members

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Forms

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Reimbursement Policy: PO-RE-156 Non-Covered Codes – Medicaid Managed Care and Child Health Plus

Obtaining Physician-Administered Drugs through a Specialty Pharmacy

Reimbursement Policy: PO-RE-155 Non-Covered Codes – Medicare

Reimbursement Policy: PO-RE-102 Taxonomy

Prior Authorization Guidelines for Select Services Effective February 1, 2026

Reimbursement Update for Contrast Agents Prescribed to Medicaid Members

Provider Attestation for OTC Plus Special Supplemental Benefits

Documentation and Coding: Diabetes Mellitus

Documentation and Coding: Pulmonary Fibrosis

Documentation and Coding: Chronic Obstructive Pulmonary Disease

Documentation and Coding: Breast Cancer

Podiatry and Peripheral Vascular Disease Prior Authorization Request

Search

Resource Type

Filter

Year

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Reimbursement Policy: PO-RE-156 Non-Covered Codes – Medicaid Managed Care and Child Health Plus

Obtaining Physician-Administered Drugs through a Specialty Pharmacy

Reimbursement Policy: PO-RE-155 Non-Covered Codes – Medicare

Reimbursement Policy: PO-RE-102 Taxonomy

Prior Authorization Guidelines for Select Services Effective February 1, 2026

Reimbursement Update for Contrast Agents Prescribed to Medicaid Members

Provider Attestation for OTC Plus Special Supplemental Benefits

Documentation and Coding: Diabetes Mellitus

Documentation and Coding: Pulmonary Fibrosis

Documentation and Coding: Chronic Obstructive Pulmonary Disease

Documentation and Coding: Breast Cancer

Podiatry and Peripheral Vascular Disease Prior Authorization Request

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