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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Effective May 1, 2025, Healthfirst will implement a new reimbursement policy for Psychological-Neuropsychological testing. This policy is aligned with Local Coverage Determination L34520 and Local Coverage Article A57780 R-10-01-2024 (Jurisdiction N).

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Reimbursement Policy
  
Documentation & Coding - Video - 2025
Video - Documentation and Coding of Major Depressive Disorder

This video offers guidance on proper clinical documentation and coding of major depressive disorder.

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Clinical Documentation Improvement
Video
  
Education Events & Patient Care Resources - Patient Resource - 2022
American Dental Association Medical Emergencies in the Dental Office
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Oral Health
  
Education Events & Patient Care Resources - Patient Resource - 2020
NYS Smokers’ Quitline Flier
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Smoking Cessation
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2020
New York State Quitline

New York State Quitline helps all New York residents quit or cut back on commercial tobacco products, like cigarettes and vaping.

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Smoking Cessation
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective July 2025

Healthfirst is adding new prior authorization requirements for selected medical services.

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Administration
Authorization
Healthfirst Plans
  
Provider Alerts - Policy, Billing, or Coverage Update - 2025
Medicare Enrollment Guidelines for Medicaid Members with End Stage Renal Disease (ESRD)

The New York State Department of Health requires Medicaid members diagnosed with End Stage Renal Disease (ESRD) to apply for Medicare.

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Administration
Medicaid
Medicare
  
Provider Alerts - Education Events & Patient Care Resources - Practice Guidelines and Tips - 2025
Help Off-Exchange Members Renew Their Coverage

New York State will resume standard annual recertification procedures for off-exchange Medicaid, HARP, LIP, CC, and SHP members.

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Administration
Medicaid
Recertification
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-134 Prenatal and Postpartum Services Cost-Sharing Waiver

Starting January 1, 2025, a new NY State of Health (NYSOH) program under New York’s Section 1332 waiver will enhance access and affordability for pregnant and postpartum Qualified Health Plan (QHP) members.

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
New Prior Authorization Requirements for CPT Codes Effective June 2025

Starting June 1, 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
  
Provider Alerts - Claims & Billing - Behavioral Health and Foster Care - Policy, Billing, or Coverage Update - 2025
Personalized Recovery Oriented Services (PROS) Redesign

The New York State (NYS) Office of Mental Health (OMH) is redesigning the Personalized Recovery Oriented Services (PROS) program.

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Reimbursement
Medicaid
Administration
Behavioral Health and Mental Health
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Updated Coverage and Reimbursement for Adverse Childhood Experiences (ACEs) Screenings for Medicaid Members

Starting January 1, 2025, Adverse Childhood Experiences (ACEs) screenings conducted in primary settings has been expanded to cover one lifetime screening for Medicaid members who are between 21 to 65 years of age. Children and adolescents up to 21 years of age continue to receive coverage for annual ACEs screenings as appropriate and medically necessary.

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Administration
Medicaid
  
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