Important Plan and Coverage Changes for 2025
These changes go into effect on Jan. 1, 2025
As part of the Inflation Reduction Act, changes are being instituted to help make healthcare more affordable. These changes could affect many of your patients.
Availity Essentials Update
Availity Essentials is Healthfirst's New Provider Portal
Access Healthfirst tools through Availity Essentials, our new provider portal designed to help make your work with us easier.
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What's New
View allEyeMed to Manage Prior Authorization for Six New Codes Starting April 2025
EyeMed manages Healthfirst’s prior authorization for surgical and therapeutic vision services as well as network management, related member and provider service calls, and claims payment for routine vision and medical optometry services.
View postPediatric Vaccine Counseling Now Covered for Medicaid and Personal Wellness Plan Members
As part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, Healthfirst will reimburse providers for pediatric vaccine counseling visits for Medicaid and Personal Wellness Plan (HARP) members under 21 years of age.
View postProvider Education Events
Check out our calendar and sign up for an event today.
View postPrior Authorization Guidelines for Select CPT and HCPCS Codes Effective March 2025
Starting March 20, 2025, Healthfirst will add prior authorization requirements for selected medical services. These changes are part of Healthfirst’s ongoing responsibility to evaluate its medical policies compared to the latest scientific evidence and specialty society guidance.
View postScheduling Configuration Changes for Linked and Mutual Visits
Starting January 1, 2025, Healthfirst is creating new service codes to accurately account for Linked and Mutual Visits provided to Medicaid, Personal Wellness Plans (HARP), Senior Health Partner (SHP) and CompleteCare (CC) members.
View postChanges to the Healthfirst Connection Plan (HMO D-SNP) and Life Improvement Plans Beginning in 2025
Starting January 1, 2025, Providers will need to bill Medicaid Fee-for-Service or Member’s Medicaid Coverage for Healthfirst Connection Plan Members’ cost sharing.
View postImportant Plan and Coverage Changes for 2025
As part of the Inflation Reduction Act, changes are being instituted to help make healthcare more affordable. These changes go into effect on January 1, 2025, and could affect many of your patients.
View postReceive updates in your email
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