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Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2026
Prior Authorization Requirements for Select Codes Starting November 30, 2026

Effective November 30, 2026, Healthfirst will require prior authorization requirements for several CPT codes.

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Administration
Healthfirst Plans
Authorization
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Vascular Dementia

This video offers guidance on proper clinical documentation and coding of Vascular Dementia

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Clinical Documentation Improvement
Video
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

This reimbursement policy describes Healthfirst's reimbursement requirements for Certified Community Behavioral Health Clinic (CCBHC) services provided to eligible Healthfirst members.

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Important Update to Electronic Remittance Advice (ERA) Distribution Logic

Healthfirst is updating the logic used to route ERA transactions.

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Administration
Reimbursement
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-172 Multiple Procedure Reduction

Healthfirst applies multiple procedure payment reductions when multiple surgical or procedural services are performed during the same operative session for the same member.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Home Sleep Tests (HSTs) are designed to help diagnose sleep disordered breathing conditions in a home-setting.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Healthfirst administers reimbursement for Vaccines for Children (VFC) services in accordance with applicable federal and New York State (NYS) laws, regulations, Medicaid requirements, and VFC program guidance, including requirements issued by the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), the New York State Department of Health (NYSDOH), and other applicable federal or state authorities.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Effective May 1st, 2025, Healthfirst implemented a new reimbursement policy for Psychological-Neuropsychological testing.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-140 Electromyography and Nerve Conduction Studies

This policy outlines the guidelines for reimbursing Electromyography (EMG) and Nerve Conduction Studies (NCS) performed to diagnose, evaluate, or manage peripheral nerve and neuromuscular disorders.

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Reimbursement Policy
  
Documentation & Coding - Practice Guidelines and Tips - 2026
Documentation and Coding: Pulmonary Hypertension

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 Hypertension (PH).

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2026
Documentation and Coding: Nursing Home Documentation Recommendations

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 Nursing Home Documentation.

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Clinical Documentation Improvement
  
Provider Alerts - Practice Guidelines and Tips - 2026
Managing Member Concerns and Grievances

These FAQs serve as a resource to help practices identify and address member concerns and dissatisfaction. Along with enhancing the quality of care and service delivery to foster a positive member experience and reduce the occurrence of complaints and grievances.

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Administration
Healthfirst Plans
  
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