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Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Anorexia Nervosa and Bulimia Nervosa

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 Anorexia Nervosa and Bulimia Nervosa.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Acute and Chronic Cor Pulmonale

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 Cor Pulmonale.

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Clinical Documentation Improvement
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2025
Clear Claim Connection (C3) SSO Now Available on Availity Essentials

Effective March 2025, the Clear Claim Connection™ (C3) tool is no longer available on Healthfirst’s legacy provider portal (https://hfproviderportal.org).

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Administration
  
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
  
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
  
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