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Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Osteomyelitis

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 Osteomyelitis.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Personality 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 Personality Disorders.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Reiter's Disease (Reactive Arthritis)

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 Reiter's Disease (Reactive Arthritis).

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Systemic Lupus Erythematosus

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 Systemic Lupus Erythematosus.

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Clinical Documentation Improvement
  
Provider Alerts - Pharmacy Resources & Formularies - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Billing Physician Administered Drugs

Healthfirst Responsibility for Physician Administered Drugs and the NYRx Program

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Medicaid
Reimbursement
Pharmacy
  
Provider Alerts - Practice Guidelines and Tips - 2025
NYS Medicaid APG Weight Adjustment for Dialysis Clinics

Effective January 1, 2026, the New York State (NYS) Medicaid program, including both Fee-for-Service (FFS) and Medicaid Managed Care (MMC) plans, will incorporate the costs of phosphate binders provided during dialysis sessions into the Ambulatory Patient Group (APG) payment.

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Administration
Medicaid
  
Provider Alerts - Practice Guidelines and Tips - 2025
Applied Behavior Analysis (ABA) Supervision Requirements

Effective October 1, 2025, the New York State Department of Health (NYS DOH) will implement updated supervision standards for Licensed Behavior Analysts (LBAs) overseeing unlicensed individuals/technicians delivering Applied Behavior Analysis (ABA) services.

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Administration
Medicaid
  
Provider Forms - Form - 2025
New York Independent Assessor Program (NYIAP) Assessment Request Form

Providers and Medicaid health plan members must complete this form if the provider believes that the member requires non-covered community based long-term services and supports and would be a candidate for a Managed Long-Term Care (MLTC) plan.

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Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization No Longer Required for Select EviCore Codes Starting January 1, 2026

Effective January 1, 2026, Healthfirst will remove prior authorization requirements for several CPT codes currently managed by Evicore.

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Administration
Healthfirst Plans
Authorization
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization Requirements for Select Services Starting January 1, 2026

CPT codes, newly released by the Centers for Medicare & Medicaid Services (CMS) and effective January 1, 2026, will include prior authorization requirements.

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Administration
Healthfirst Plans
Authorization
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization Requirements for Select Services Starting April 1, 2026

Effective April 1, 2026, Healthfirst will add prior authorization requirements for select medical services for Medicare Plans only.

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Administration
Healthfirst Plans
Medicare
Reimbursement
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-132 Obstetric Billing Guidelines

This policy describes the reimbursement of global obstetrical (OB) codes and the itemization of maternity care services. Maternity care encompasses prenatal, delivery, antepartum, and postpartum care.

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Reimbursement Policy
  
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