What's New

Signature (PPO) Out-Of-Network Providers' QRG

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

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.

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.

Seasonal Influenza (Flu) Annual Vaccine

Help address patient concerns regarding the flu shot.

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

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.

Reminder: Prior Authorization for Genetic and Molecular Laboratory Services

eviCore providing authorization services for Genetic and Molecular laboratory services.

Reminder regarding members who seek mental health or substance abuse services

Child HCBS Authorizations and Reminder of State Billing and Claiming Requirements

This notice is to remind Children’s Home and Community-Based Services (HCBS) providers of HCBS billing and claiming requirements, per the April 4, 2022, NYSDOH memo.

Community Oriented Recovery and Empowerment (CORE) Services

Four Behavioral Health Home and Community Based Services transitioning to a new service array called CORE Services

Telehealth Resources Available

For best practices, coding and billing tip sheets, and more