Supporting Your Patients: Coverage Changes in 2026 and Beyond
Help members navigate their coverage options and maintain access to the care they need.
Review the latest updates, tools, and materials to support these conversations.
Provider Updates for August 2026
Stay ahead of important changes that may impact your practice
Review updates to prior authorization, reimbursement policies, provider manual changes, and more—all in one place.
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What's New
View allUpdate to Electronic Remittance Advice (ERA) Distribution Logic
This is part of an ongoing effort to improve the accuracy and consistency of Electronic Remittance Advice (ERA) delivery.
View postHow to Request a Continuous Glucose Monitoring Device
These devices must be obtained through an in-network Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) provider, rather than a pharmacy.
View postPrior Authorization Requirements for Select Codes Starting November 30, 2026
Effective November 30, 2026, Healthfirst will require prior authorization requirements for several CPT codes.
View postReminder: Non-Covered Codes for Medicaid Managed Care and Child Health Plus Reimbursement Policy Effective Feb. 1, 2026
Healthfirst is aligning with NYS Medicaid Billing Guidelines to ensure consistency in claims processing and reimbursement.
View postReimbursement Policies Posted August 2026
(Post updated 8/11/26) Providers are encouraged to review these policies to ensure compliance with current billing and reimbursement requirements.
View postManaging Member Concerns and Grievances
These FAQs serve as a resource to help practices identify and address member concerns and dissatisfaction. Along with enhancing the quality of care and service delivery to foster a positive member experience and reduce the occurrence of complaints and grievances.
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