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Documentation & Coding - Practice Guidelines and Tips - 2026
Documentation and Coding: Chronic Obstructive Pulmonary Disease

This tip sheet is intended to assist providers and coding staff with the documentation and on services submitted to Healthfirst—specifically for Chronic Obstructive Pulmonary Disease (COPD).

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2026
Documentation and Coding: Aspiration Pneumonia

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 types of Aspiration Pneumonia.

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Clinical Documentation Improvement
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-177 CCBHC Provider Billing Guidance – QHP (UB-04 Billing)

This reimbursement policy describes Healthfirst's reimbursement requirements for Certified Community Behavioral Health Clinic (CCBHC) services provided to eligible members enrolled in Healthfirst Qualified Health Plan (QHP) product.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-174 Routine and Non- Routine Foot Care

This reimbursement policy establishes coverage and reimbursement requirements for routine and non-routine foot care services across applicable Healthfirst lines of business.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

This policy outlines Healthfirst's reimbursement methodology for Evaluation and Management (E/M) services and additional office and outpatient services billed on the same date of service.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-117 Fertility and Preservation Services

This reimbursement policy outlines Healthfirst's reimbursement requirements for infertility and fertility preservation services.

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Reimbursement Policy
  
Pharmacy Resources & Formularies - Provider Resources - 2026
Prior Authorization Pharmacy Medical Benefit Grid

It is the policy of Healthfirst to require prior authorization for medical claims for all medications listed within this document. To learn more, including ways to submit prior authorization, access this resource.

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Authorization
  
Documentation & Coding - Practice Guidelines and Tips - 2026
Documentation and Coding: Severe Skin Burns

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 Severe Skin Burns.

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Clinical Documentation Improvement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Prior Authorization Required for Select Services Starting October 1, 2026

CPT/HCPCS Level II codes newly released by the American Medical Association (AMA) and The Centers for Medicaid and Medicare Services - effective October 1, 2026 - will require prior authorization and will be managed by Healthfirst’s delegated vendor(s) EviCore, under the EviCore Lab Program and Integra.

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Administration
Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Prior Authorization Requirements for Select Codes Starting December 30, 2026

Effective December 30, 2026, Healthfirst will require prior authorization for select codes. 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
Healthfirst Plans
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-141 Interprofessional Consultation for Behavioral Health Services

This reimbursement policy outlines the guidelines for billing and reimbursement of interprofessional consultations in behavioral health services as established by the Centers for Medicare & Medicaid Services (CMS) starting in 2025.

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Reimbursement Policy
  
Education Events & Patient Care Resources - Video - 2026
Provider Education Events - Recorded Video Sessions

Browse our previously recorded webinars and training sessions.

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Provider Events
  
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