Where to submit your requests
View postA provider questionnaire will now accompany initial prior authorization requests for Adult Physical Therapy across all Healthfirst plans to support efficient reviews and appropriate care decisions.
View postEffective August 1, 2026, Healthfirst will implement Cotiviti’s Claim Pattern Review Program to conduct ongoing reviews of specific professional claims.
View postCodes newly released by the Centers for Medicare and Medicaid Services (CMS) on April 1, 2026, will include prior authorization requirements starting June 1, 2026.
View postEffective July 1, 2026, Healthfirst will require prior authorization requirements for several CPT codes.
View postProviders can access all Healthfirst tools through Availity Essentials, our new secure provider portal platform.
View postEffective June 1, 2026, Integra Partners will manage prior authorization (Utilization Management) for all Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) on behalf of Healthfirst for all plans.
View postStarting June 1, 2026, Healthfirst providers will need to submit prior authorizations via Optum’s Spine, Pain, and Joint portal as the OrthoNet portal will be discontinued.
View postEffective April 1, 2026, Healthfirst will require prior authorization requirements for several CPT codes currently managed by Evicore.
View postEffective January 1, 2026, cost sharing will not apply to Essential Plan (EP) members receiving Mobile Crisis Services. This includes Healthfirst EP 1, 2, 3, 4, and 200–250 plans.
View postEffective April 1, 2026, Healthfirst will remove prior authorization requirements for several CPT codes currently managed by Integra.
View postHealthfirst is reinforcing New York State Department of Health (NYSDOH) requirements regarding newborn coverage rules.
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