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Posted Jun 06, 2023
Children's Home and Community-Based Care (HCBS) FAQ

This FAQ provides important workflow reminders, answers to questions you may have about HCBS, and other helpful resources.

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Posted May 24, 2023
Coronavirus Telehealth Services

This document outlines the Healthfirst Telemedicine Reimbursement Policy.

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Posted May 17, 2023
Behavioral Health UR Implementation

Healthfirst's new, trigger-based approach to utilization review (UR) for certain acute mental health services.

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Posted May 10, 2023
Authorization Requirement Update for Vision Services

Effective May 1, 2023, Healthfirst no longer requires authorization for these selected vision services.

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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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