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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
  
Provider Alerts - Practice Guidelines and Tips - 2025
Concurrent Review Updates for Select Child and Family Treatment and Support Services (CFTSS)

Effective September 1, 2025, Healthfirst will implement Concurrent review for Psychosocial Rehabilitation (PSR) and Community Psychiatric Supports and Treatment (CPST) services under the Children and Family Treatment and Support Services (CFTSS) benefit.

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Reimbursement
Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Practice Guidelines and Tips - 2025
FAQ for Concurrent Review Updates for Select Child and Family Treatment and Support Services (CFTSS)

Answers to frequently asked questions (FAQs) regarding Healthfirst implementation of concurrent review for Psychosocial Rehabilitation (PSR) and Community Psychiatric Supports and Treatment (CPST) services under the Children and Family Treatment and Support Services (CFTSS) benefit, effective September 1, 2025.

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Reimbursement
Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Pharmacy Resources & Formularies - Claims & Billing - Policy, Billing, or Coverage Update - 2025
New Physician Dispenser Policy

New York State Department of Health has requested that Healthfirst notify practitioners of this change and inform them that they will need to bill claims through the Medical benefit after September 1, 2022, to be reimbursed.

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Administration
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2025
Eighth Annual World Health Continuing Medical Education Conference, Panel 1

Health Disparities Impacting Global and Local Populations (June 6, 2025)

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2025
Eighth Annual World Health Continuing Medical Education Conference, Panel 2

Health Disparities Impacting Global and Local Populations (June 6, 2025)

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2025
Eighth Annual World Health Continuing Medical Education Conference, Panel 3

Health Disparities Impacting Global and Local Populations (June 6, 2025)

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2025
Eighth Annual World Health Continuing Medical Education Conference, Panel 4

Health Disparities Impacting Global and Local Populations (June 6, 2025)

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Provider Events
  
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