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What's New

Posted Apr 06, 2023
Provider Alert - 2023 FPL Expansion

Thanks to expanded eligibility, more Medicare beneficiaries will qualify for the Medicare Savings Program (MSP) in 2023.

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Posted Apr 04, 2023
Provider Alert: Medicaid FFS Enrollment Requirement for Providers

Provider Alert: Medicaid FFS Enrollment Requirement for Providers

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Posted Mar 22, 2023
Transition of Pharmacy Benefit from Managed Care to Fee-for-Service

Effective April 1, 2023, Medicaid members enrolled in MMC Plans, HARPs, and SNPs will receive their pharmacy benefits through the NYRx Pharmacy program.

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Posted Mar 14, 2023
Healthfirst Cares powered by Welldoc® App

Healthfirst + Welldoc brings innovative diabetes care to members.

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Posted Mar 07, 2023
Reimbursement Policies for Laboratory Services

Effective June 1, 2023, Healthfirst is updating reimbursement policies for laboratory service providers with respect to our new partnership with Avalon Healthcare Solutions.

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Posted Jan 11, 2023
Signature (PPO) Out-Of-Network Providers' QRG

Coverage and accessibility information for out-of-network providers regarding this Medicare Advantage plan

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Posted Jan 09, 2023
Expanded Partnership with eviCore

This expansion includes the management of prior authorization for medical oncology services requested for our members enrolled in all Healthfirst plans, except for the Senior Health Partners MLTC plan.

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Posted Jan 05, 2023
CMS Final Rule: CY2023 Medicare Advantage Plans' Maximum Out-of-Pocket (MOOP) Limits

Effective 1/1/2023, the maximum out-of-pocket (MOOP) limit for a Medicare Advantage (MA) plan (after which the plan pays 100% of MA costs) will be calculated based on the accrual of all Medicare-covered cost sharing.

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Posted Dec 29, 2022
Seasonal Influenza (Flu) Annual Vaccine

Help address patient concerns regarding the flu shot.

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Posted Dec 06, 2022
Updating and Certifying Provider Data

Healthfirst would like to remind you to review your National Provider Identifier (NPI) data in the National Plan & Provider Enumeration System (NPPES) as soon as possible to ensure that the provider data displayed is accurate

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Posted Dec 01, 2022
Behavioral Health Benefit Carve-in to Medicaid Advantage Plus Plans

Effective January 1, 2023, New York State is carving additional Behavioral Health services into the Medicaid Advantage Plus plan.

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Posted Nov 18, 2022
Personalized Recovery Oriented Services (PROS) Update

Effective Nov. 21, 2022, Healthfirst, in accordance with the State of New York, will no longer require prior authorization for Personalized Recovery Oriented Services (PROS).

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