Healthfirst for Providers

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-003 Folate Testing

Folate, or vitamin B9, is a generic term for a water-soluble vitamin obtained from the diet that is involved in the transfer of methyl groups (i.e., single carbon-containing groups) in multiple biochemical metabolic pathways, including nucleic acid biosynthesis and methionine/homocysteine metabolism.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

Thyroid hormones are necessary for both prenatal and postnatal development, as well as metabolic activity in adults

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Reimbursement Policy

Documentation & Coding - Practice Guidelines and Tips - 2026

Documentation and Coding: Lysosomal Storage Disorders

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 Lysosomal Storage Disorders.

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Clinical Documentation Improvement

Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026

Prior Authorization Required for Newly Released Codes Starting July 1, 2026

Codes newly released by the American Medical Association will include prior authorization requirements starting July 1, 2026.

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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026

Prior Authorization Required for Select Codes Starting October 1, 2026

Effective October 1, 2026, Healthfirst will require prior authorization for select medical services.

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Healthfirst Plans

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Reimbursement

Education Events & Patient Care Resources - Provider Resources - 2026

Provider Education Events

See our calendar of provider education events and register today.

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Provider Events

Provider Forms - Form - 2026

Post-Discharge Meals Benefit

Post-Discharge Meals Benefit FAQs and forms are available in English, Spanish and Chinese.

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Forms

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-169 Medical Dental and Oral Health Coverage

Healthfirst recognizes that certain dental services are medically necessary and eligible for reimbursement when covered under a member’s medical benefit in accordance with Centers for Medicare & Medicaid Services (CMS) guidelines and applicable state and federal regulations.

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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 additional office and outpatient services billed in conjunction with Evaluation and Management (E&M) services and other qualifying encounters, when performed on the same date of services for the same member by the same provider.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-110 Preventive Care Services (Commercial Plans)

Healthfirst recognizes the importances of preventive care in promoting overall health and well-being. To support our members in maintaining good health and preventing illnesses, we provide coverage for a range of preventive services in accordance with this policy.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-088 National Drug Code Billing Requirements

This policy describes the National Drug Code (NDC) information that is required on professional and outpatient facility drug claims that are reported for reimbursement.

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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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Reimbursement Policy: PO-RE-003 Folate Testing

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

Documentation and Coding: Lysosomal Storage Disorders

Prior Authorization Required for Newly Released Codes Starting July 1, 2026

Prior Authorization Required for Select Codes Starting October 1, 2026

Provider Education Events

Post-Discharge Meals Benefit

Reimbursement Policy: PO-RE-169 Medical Dental and Oral Health Coverage

Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

Reimbursement Policy: PO-RE-110 Preventive Care Services (Commercial Plans)

Reimbursement Policy: PO-RE-088 National Drug Code Billing Requirements

Prior Authorization Pharmacy Medical Benefit Grid

Search

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-003 Folate Testing

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

Documentation and Coding: Lysosomal Storage Disorders

Prior Authorization Required for Newly Released Codes Starting July 1, 2026

Prior Authorization Required for Select Codes Starting October 1, 2026

Provider Education Events

Post-Discharge Meals Benefit

Reimbursement Policy: PO-RE-169 Medical Dental and Oral Health Coverage

Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

Reimbursement Policy: PO-RE-110 Preventive Care Services (Commercial Plans)

Reimbursement Policy: PO-RE-088 National Drug Code Billing Requirements

Prior Authorization Pharmacy Medical Benefit Grid

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