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Posted Mar 27, 2025
Medicare Enrollment Guidelines for Medicaid Members with End Stage Renal Disease (ESRD)

The New York State Department of Health requires Medicaid members diagnosed with End Stage Renal Disease (ESRD) to apply for Medicare.

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Posted Mar 24, 2025
Help Off-Exchange Members Renew Their Coverage

New York State will resume standard annual recertification procedures for off-exchange Medicaid, Personal Wellness Plan (HARP), Life Improvement Plan (LIP), CompleteCare (CC), and Senior Health Partners (SHP) members.

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Posted Feb 25, 2025
Personalized Recovery Oriented Services (PROS) Redesign

The New York State (NYS) Office of Mental Health (OMH) is launching a redesign of the Personalized Recovery Oriented Services (PROS) program, effective April 1, 2025.

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Posted Feb 19, 2025
Updated Coverage and Reimbursement for Adverse Childhood Experiences (ACEs) Screenings for Medicaid Members

ACEs screenings conducted in primary settings has been expanded to cover one lifetime screening for Medicaid members between 21 to 65 years of age. Children and adolescents up to 21 years of age continue to receive coverage for annual ACEs screenings as appropriate and medically necessary.

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Posted Feb 11, 2025
Prior Authorization No Longer Required for Select Evicore Codes Starting April 2025

Providers will no longer need to submit prior authorization requests to Evicore for select codes.

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Posted Feb 05, 2025
Physician Order Documentation Process for Licensed Home Care Service Agencies

Licensed Home Care Service Agencies are required to obtain and document a physician order before providing personal care services and private duty nursing to Senior Health Partner, CompleteCare, and Medicaid Members.

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Posted Feb 01, 2025
CAHPS Season is Here!

Here’s what you need to know about the annual Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey.

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Posted Jan 31, 2025
Provider Education Events

This page has moved and is no longer being updated.

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Posted Jan 30, 2025
Reminder Regarding Diabetic Testing Supplies

Ascenia/Bayer (Contour and Contour Next) products

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Posted Jan 28, 2025
New Prior Authorization Requirements for CPT Codes Effective April 2025

Starting April 6, 2025, Healthfirst will add prior authorization requirements for selected medical services.

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Posted Jan 22, 2025
EyeMed to Manage Prior Authorization for Six New Codes Starting April 2025

EyeMed manages Healthfirst’s prior authorization for surgical and therapeutic vision services as well as network management, related member and provider service calls, and claims payment for routine vision and medical optometry services.

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Posted Jan 14, 2025
Pediatric Vaccine Counseling Now Covered for Medicaid and Child Health Plus Members

As part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, Healthfirst will reimburse providers for pediatric vaccine counseling visits for Medicaid and Child Health Plus members under 21 years of age.

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