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Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2026
Request a Continuous Glucose Monitoring Device for Healthfirst Medicare, Essential Plan, and Qualified Health Plan Members

Healthfirst members with Type 1 or Type 2 diabetes may qualify for a Continuous Glucose Monitoring (CGM) device if eligible. Available to Medicare, Essential Plan, and QHP members through an in-network DMEPOS provider, not a pharmacy.

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Administration
Healthfirst Plans
Authorization
Reimbursement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Aneurysm

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 an Aneurysm.

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Clinical Documentation Improvement
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-166 Non-Coverage of CPT Code 80050

Effective July 1, 2026, Healthfirst will no longer reimburse for CPT code 80050 (General Health Panel).

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Reimbursement Policy
  
Education Events & Patient Care Resources - Plans & Benefits - Practice Guidelines and Tips - 2026
2026 Special Needs Plan Model of Care Provider Training

This presentation will help educate providers, delegated vendors, and appropriate staff on the Healthfirst Special Needs Plan (SNP) Model of Care (MOC), the goal of which is to enhance member health outcomes through the use of an integrated care delivery system

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Administration
  
Education Events & Patient Care Resources - Plans & Benefits - Practice Guidelines and Tips - 2025
2025 Special Needs Plan Model of Care Provider Training

This presentation will help educate providers, delegated vendors, and appropriate staff on the Healthfirst Special Needs Plan (SNP) Model of Care (MOC), the goal of which is to enhance member health outcomes through the use of an integrated care delivery system.

Open external link
Administration
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Myocardial Infarction

This video offers guidance on proper clinical documentation and coding of Myocardial Infarction.

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Clinical Documentation Improvement
Video
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-162 Diagnostic Laboratory

This policy outlines Healthfirst's standards and requirements for the reimbursement of diagnostic laboratory services.

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Introducing Genetic and Molecular Coding Validation from Concert Genetics

Effective May 1, 2026, Healthfirst is updating reimbursement policies for genetic and molecular lab testing for all Healthfirst Plans with respect to our new partnership with Concert Genetics

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Administration
Healthfirst Plans
Authorization
Reimbursement Policy
  
Provider Alerts - Plans & Benefits - Policy, Billing, or Coverage Update - 2026
New York State Essential Plan 200-250 Coverage to End Effective 7/1/2026

The New York State Essential Plan coverage for individuals with incomes between 200% and 250% of the Federal Poverty Level (FPL) will end effective July 1, 2026.

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Healthfirst Plans
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-163 Online Digital (e-Visit) Services

This policy outlines Healthfirst’s criteria for reimbursing e-Visits, a form of asynchronous, patient-initiated communication that takes place through a secure, HIPAA-compliant digital platform, most commonly a patient portal.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-109 Vaccine Administration

Healthfirst acknowledges the importance of vaccination in promoting public health and aims to align its reimbursement policies with the Centers for Disease Control (CDC)/ Advisory Committee on Immunization Practices (ACIP), and other applicable New York State and local public health authorities, including New York State Department of Health (NYSDOH) and New York City Department of Health and Mental Hygiene (NYC DOHMH).

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Introducing Claim Pattern Review Program from Cotiviti

Effective August 1, 2026, Healthfirst will implement Cotiviti’s Claim Pattern Review Program to conduct ongoing reviews of specific professional claims.

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Administration
Healthfirst Plans
Reimbursement
  
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