Effective September 1, 2025, Healthfirst will implement concurrent review for Psychosocial Rehabilitation (PSR) and Community Psychiatric Supports and Treatment (CPST) services under the Children and Family Treatment and Support Services (CFTSS) benefit.
View postEffective Jan 1, 2025, The Centers for Medicare & Medicaid Services (CMS) finalized several updates to the Medicare Diabetes Prevention Program (MDPP).
View postReimbursement Updates for eConsults
View postEffective Jan 1, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the 2025 Medicare Physician Fee Schedule Final Rule with key updates impacting Preventive Services for Medicare members.
View postStarting September 3, 2025, Healthfirst providers will need to submit prior authorizations via Optum’s Spine, Pain, and Joint portal as the OrthoNet portal will be discontinued.
View postIn accordance with Chapter 645 of the Laws of 2005, the New York State (NYS) Medicaid program does not cover prescription or physician-administered drugs used for the treatment of sexual dysfunction (SD) or erectile dysfunction (ED).
View postLearn more about prior authorization guidelines for select Remote Patient (RPM) and Remote Therapeutic Monitoring (RTM) services, effective September 1, 2025.
View postThe New York State Department of Health requires Medicaid members diagnosed with End Stage Renal Disease (ESRD) to apply for Medicare.
View postNew 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.
View postThe 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.
View postACEs 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.
View postProviders will no longer need to submit prior authorization requests to Evicore for select codes.
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