Posted Jun 29, 2026
Learn more about key updates providers should know.
Each month, Healthfirst shares key updates to help you stay informed, prepared, and supported. Below you’ll find important changes and opportunities for the upcoming month. We encourage you to review each section carefully and explore the links provided for full details.
Review these reimbursement policies to understand how they may impact claims submission and payment.
| Policy Name (click name to view) |
|---|
| Non-Coverage of CPT Code 80050 |
| Clinical Research Studies (Clinical Trials) |
To see all our reimbursement policies, visit HFproviders.org/Reimbursement-Policies.
Understanding these updates now can help you avoid delays and ensure a smooth experience for your patients and staff.
| Provider Alert (click name to view) |
|---|
| Prior Authorization Required for Select Codes Starting July 1, 2026 |
| New Lab Codes with Prior Authorization Requirements Starting July 1, 2026 |
See all provider alerts at HFproviders.org/provider-alerts.
Staying current with updates made to the provider manual helps ensure compliance and alignment with Healthfirst requirements.
| Section | Description of Update |
|---|---|
| Section 2.1 and Section 16.6 | As the Essential Plan 200-250 (EP 200-250) coverage is ending effective 7/1/2026, these sections have been updated to remove references to EP 200-250 |
| Section 15.4 (Organization Determinations and Reconsiderations [Appeals] – Medicare) |
Includes a new subsection on appeal determinations for Dual-Eligible Medicaid Advantage Plus Members |
| Section 15.5 (Expedited Organization Determinations) |
Title has been updated and information on expedited appeals has been relocated to Section 15.10 |
| Section 15.10 (Expedited Appeals – Medicaid, Child Health Plus, Senior Health Partners, and Medicaid Advantage Plus) |
Includes additional information around expedited appeals as well as additional examples of when providers may file expedited appeal requests |
| Section 15.13 (External Review – Medicaid, CHPlus, Medicaid Advantage Plans, Essential Plans, and Healthfirst Leaf Plans) |
Includes additional clarifying information on filing external appeals for denials related to non-medically necessary services, clinical trials or treatments for rare diseases, and/or when out-of-network services are denied due to the service being materially different from in-network services or considered treatment for a rare disease |
See the Provider Manual here.
See all provider education events here.
