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New Posted May 30, 2025
2025 Medicare Physician Fee Schedule Final Rule

Effective Jan 1, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the 2025 Medicare Physician Fee Schedule Final Rule with key updates impacting Preventive Services for Medicare members.

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New Posted May 30, 2025
Changes to Prior Authorization Submissions for Back Pain Management and Spinal Surgery Services

Starting September 3, 2025, Healthfirst providers will need to submit prior authorizations via Optum’s Spine, Pain, and Joint portal as the OrthoNet portal will be discontinued.

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New Posted May 30, 2025
Prior Authorization Requirements for Drugs, Supplies, and Procedures for Sexual Dysfunction or Erectile Dysfunction

In accordance with Chapter 645 of the Laws of 2005, the New York State (NYS) Medicaid program does not cover prescription or physician-administered drugs used for the treatment of sexual dysfunction (SD) or erectile dysfunction (ED).

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New Posted May 29, 2025
Prior Authorization Guidelines for Select Remote Patient and Remote Therapeutic Monitoring Services

Learn more about prior authorization guidelines for select Remote Patient (RPM) and Remote Therapeutic Monitoring (RTM) services, effective September 1, 2025.

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Posted May 06, 2025
See the latest news about Availity Essentials™

Providers can access Healthfirst tools through Availity Essentials, our new secure provider portal platform.

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Posted Mar 27, 2025
Medicare Enrollment Guidelines for Medicaid Members with End Stage Renal Disease (ESRD)

The New York State Department of Health requires Medicaid members diagnosed with End Stage Renal Disease (ESRD) to apply for Medicare.

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Posted Mar 24, 2025
Help Off-Exchange Members Renew Their Coverage

New York State will resume standard annual recertification procedures for off-exchange Medicaid, Personal Wellness Plan (HARP), Life Improvement Plan (LIP), CompleteCare (CC), and Senior Health Partners (SHP) members.

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Posted Feb 25, 2025
Personalized Recovery Oriented Services (PROS) Redesign

The New York State (NYS) Office of Mental Health (OMH) is launching a redesign of the Personalized Recovery Oriented Services (PROS) program, effective April 1, 2025.

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Posted Feb 19, 2025
Updated Coverage and Reimbursement for Adverse Childhood Experiences (ACEs) Screenings for Medicaid Members

ACEs screenings conducted in primary settings has been expanded to cover one lifetime screening for Medicaid members between 21 to 65 years of age. Children and adolescents up to 21 years of age continue to receive coverage for annual ACEs screenings as appropriate and medically necessary.

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Posted Feb 11, 2025
Prior Authorization No Longer Required for Select Evicore Codes Starting April 2025

Providers will no longer need to submit prior authorization requests to Evicore for select codes.

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Posted Feb 05, 2025
Physician Order Documentation Process for Licensed Home Care Service Agencies

Licensed Home Care Service Agencies are required to obtain and document a physician order before providing personal care services and private duty nursing to Senior Health Partner, CompleteCare, and Medicaid Members.

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Posted Feb 01, 2025
CAHPS Season is Here!

Here’s what you need to know about the annual Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey.

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