HF Logo HF Logo Provider Portal Login
Provider Home / Provider Alerts
Resource Type
Clear All
Filter
Year
Sort By
Showing 1-12 of 200
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Changes to Prior Authorization Submissions for Back Pain Management and Spinal Surgery Services

Starting June 1, 2026, Healthfirst providers will need to submit prior authorizations via Optum’s Spine, Pain, and Joint portal as the OrthoNet portal will be discontinued.

View Post
Reimbursement
Healthfirst Plans
Administration
Authorization
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Integra Partners to Manage Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Prior Authorization Requests Effective June 1, 2026

Effective June 1, 2026, Integra Partners will manage prior authorization (Utilization Management) for all Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) on behalf of Healthfirst for all plans.

View Post
Administration
Authorization
Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Manufacturer Withdrawal from the Medicaid Drug Rebate Program (MDRP)

Effective January 1, 2026, several drug manufacturers have voluntarily withdrawn from participation in the Medicaid Drug Rebate Program (MDRP). In accordance with federal requirements, NYRx will no longer provide Medicaid coverage for drugs manufactured by the companies listed in this provider alert.

View Post
Administration
Healthfirst Plans
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Prior Authorization Required for Select Codes Starting April 1, 2026

Effective April 1, 2026, Healthfirst will require prior authorization requirements for several CPT codes currently managed by Evicore.

Open external link
Administration
Healthfirst Plans
Authorization
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Prior Authorization No Longer Required for Select Codes Starting April 1, 2026

Effective April 1, 2026, Healthfirst will remove prior authorization requirements for several CPT codes currently managed by Integra.

Open external link
Administration
Healthfirst Plans
Authorization
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
Essential Plan: What Providers Must Know about Newborn Enrollment

Healthfirst is reinforcing New York State Department of Health (NYSDOH) requirements regarding newborn coverage rules. This alert highlights the importance of timely newborn reporting, billing, and enrollment.

View Post
Administration
Medicaid
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
CMS Cell and Gene Therapy (CGT) Access Model for Casgevy™ (exagamglogene autotemcel) and Lyfgenia® (lovotibeglogene)

Medicaid Practitioner Administered Drugs Update

View Post
Administration
Healthfirst Plans
Medicaid
  
Provider Alerts - Pharmacy Resources & Formularies - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Billing Physician Administered Drugs

Healthfirst Responsibility for Physician Administered Drugs and the NYRx Program

View Post
Medicaid
Reimbursement
Pharmacy
  
Provider Alerts - Practice Guidelines and Tips - 2025
NYS Medicaid APG Weight Adjustment for Dialysis Clinics

Effective January 1, 2026, the New York State (NYS) Medicaid program, including both Fee-for-Service (FFS) and Medicaid Managed Care (MMC) plans, will incorporate the costs of phosphate binders provided during dialysis sessions into the Ambulatory Patient Group (APG) payment.

View Post
Administration
Medicaid
  
Provider Alerts - Practice Guidelines and Tips - 2025
Applied Behavior Analysis (ABA) Supervision Requirements

Effective October 1, 2025, the New York State Department of Health (NYS DOH) will implement updated supervision standards for Licensed Behavior Analysts (LBAs) overseeing unlicensed individuals/technicians delivering Applied Behavior Analysis (ABA) services.

View Post
Administration
Medicaid
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization No Longer Required for Select EviCore Codes Starting January 1, 2026

Effective January 1, 2026, Healthfirst will remove prior authorization requirements for several CPT codes currently managed by Evicore.

Open external link
Administration
Healthfirst Plans
Authorization
Reimbursement
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization Requirements for Select Services Starting January 1, 2026

CPT codes, newly released by the Centers for Medicare & Medicaid Services (CMS) and effective January 1, 2026, will include prior authorization requirements.

Open external link
Administration
Healthfirst Plans
Authorization
Reimbursement
  
You are now navigating away from the Healthfirst website.

Links to non-Healthfirst websites are provided for your convenience only. Healthfirst is not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.