Providers are encouraged to review these policies to ensure compliance with current billing and reimbursement requirements.
View postThe Healthfirst Clinical Documentation and Coding team offers resources to support accurate, complete documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for breast cancer.
View postLearn more about key updates providers should know.
View postCPT/HCPCS Level II codes newly released by the American Medical Association (AMA) and The Centers for Medicaid and Medicare Services - effective October 1, 2026 - will require prior authorization and will be managed by Healthfirst’s delegated vendor(s) EviCore, under the EviCore Lab Program and Integra.
View postHealthfirst will require prior authorization for select codes.
View postIn August 2026, USCIS updated Public Charge guidance, expanding case-by-case consideration of individual circumstances. Healthfirst encourages members to seek guidance before making changes to their or their children’s health coverage.
View postThe Healthfirst Clinical Documentation and Coding team offers resources to support accurate, complete documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for prostate cancer.
View postLearn more about key updates providers should know.
View postEffective November 30, 2026, Healthfirst will require prior authorization requirements for several CPT codes.
View postThis is part of an ongoing effort to improve the accuracy and consistency of Electronic Remittance Advice (ERA) delivery.
View postHealthfirst is aligning with NYS Medicaid Billing Guidelines to ensure consistency in claims processing and reimbursement.
View postThese devices must be obtained through an in-network Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) provider, rather than a pharmacy.
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