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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-045 Biomarkers for Myocardial Infarction and Chronic Heart Failure

Cardiac biomarkers are the biochemical markers released in blood from injured myocardial tissue in both acute and chronic conditions, such as myocardial infarction or heart failure. They become elevated in blood after a certain period and can be measured.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-043 Biochemical Markers of Alzheimer Disease and Dementia

Alzheimer disease (AD) is a neurodegenerative disease defined by a gradual decline in memory, cognitive functions, gross atrophy of the brain, and accumulation of extracellular amyloid plaques and intracellular neurofibrillary tangles (Karch et al., 2014).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-040 Oral Cancer Screening and Testing

Oral cancer is defined as cancer occurring in the oral cavity between the vermilion border of the lips and the junction of the hard and soft palates or the posterior one third of the tongue. Squamous cell carcinoma is the most common type of oral cancer (Gross et al., 2024).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
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
  
Provider Alerts - Practice Guidelines and Tips - 2025
Physician Order Documentation Process for Licensed Home Care Service Agencies

Licensed Home Care Service Agencies (LHCSA) are required to obtain and document a Physician’s Order before providing Personal Care Services and Private Duty Nursing to Senior Health Partner, CompleteCare, and Medicaid Members.

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Licensed Home Care Services Agencies
Administration
Medicaid
Medicare
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Additional Prior Authorization Codes Managed by EyeMed, Effective April 2025

Starting April 1, 2025, EyeMed will manage prior authorization for six new codes.

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Authorization
Dental and/or Vision
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective March 2025

Starting March 20, 2025, Healthfirst will add prior authorization requirements for selected medical services.

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Administration
Authorization
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2025
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective April 2025

Starting April 6, 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
  
Education Events & Patient Care Resources - Patient Resource - 2020
New York State Department of Health AIDS Institute Resource Directory
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Infectious Diseases
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-114 Medical Nutrition Therapy and Counseling

This policy outlines the reimbursement guidelines for Medical Nutrition Therapy and Counseling. Healthfirst will reimburse covered Medical Nutrition Therapy and Counseling services provided by licensed professionals.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-039 In Vitro Chemoresistance and Chemosensitivity Assays

In vitro chemotherapy sensitivity and resistance assays refer to any in vitro laboratory analysis that is performed specifically to evaluate whether tumor growth is inhibited by a known chemotherapy drug or, more commonly, a panel of drugs (Hatok et al., 2009; Schrag et al., 2004)

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-035 Prostate Biopsy Specimen Analysis

Prostate cancer is characterized by a malignancy of the small walnut-shaped gland that produces seminal fluid. This malignancy can present with a wide clinical range, from only being a microscopic, well-differentiated tumor that may never be clinically significant all the way to being an aggressive, high-grade cancer (Taplin & Smith, 2024).

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Reimbursement Policy
  
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