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Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Quadriplegia

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 Quadriplegia.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Sickle Cell Disorders

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 Sickle Cell Disorders.

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Clinical Documentation Improvement
  
Provider Alerts - General Update - 2025
Important Update Regarding NewYork-Presbyterian and Healthfirst

Healthfirst’s highest priority is ensuring our members have access to the quality care they need.

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Administration
  
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
  
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-137 Appropriate Use of Manifestation Diagnosis Codes

Healthfirst is committed to ensuring accurate and compliant claims submission through the correct use of diagnosis coding, specifically emphasizing the appropriate application of Manifestation Codes.

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Changes To Opioid Treatment Program (OTP) Bundle Rate Billing Requirements Effective November 3, 2025

Updated Billing Requirements to Opioid Treatment Program (OTP)

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Reimbursement
Medicaid
Administration
  
Provider Alerts - Compliance, Regulatory & Policies - Practice Guidelines and Tips - 2025
Important Notice Regarding U.S. Department of Justice Regulations on Sensitive Personal Data

The United States Department of Justice (DOJ) has issued new regulations titled the “Final Rule on Preventing Access to U.S. Sensitive Personal Data and United States Government-Related Data by Countries of Concern”, codified at 28 C.F.R. Part 202.

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Healthfirst Plans
Administration
  
Provider Alerts - Practice Guidelines and Tips - 2025
2025 Medicare Diabetes Prevention Program (MDPP) Expanded Model Updates

Effective Jan 1, 2025, The Centers for Medicare & Medicaid Services (CMS) finalized several updates to the Medicare Diabetes Prevention Program (MDPP).

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Reimbursement
Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Electronic Consultation (eConsult) Reimbursement

Reimbursement Updates for eConsults

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Administration
Reimbursement
Healthfirst Plans
  
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