Healthfirst Prior Authorization Lookup
Latest Healthfirst prior authorization updates3
- Prior AuthReimbursement/Payment PolicyEff. 2026-06-01Prior-Authorization HCPCS Code List for Healthfirst PlansThis document lists Healthcare Common Procedure Codes (HCPC) that must be used when submitting prior-authorization requests for Healthfirst health plans; it affects providers submitting PA requests for durable medical equipment, supplies, enteral/parenteral nutrition, respiratory equipment, wheelchairs, and related items.All Healthfirst updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-01Interoperability and Prior Authorization Final Rule Requirements — Prior Authorization and Concurrent Review TimeframesThis document governs Healthfirst's prior authorization and concurrent review decision timeframes in accordance with the Interoperability and Prior Authorization Final Rule and applicable CMS/NYSDOH standards; it affects Healthfirst enrollees and contracted providers across the listed product lines.All Healthfirst updates
- Prior AuthClinical/Medical PolicyEff. 2020-10-01Exon-skipping therapies for Duchenne muscular dystrophy (eteplirsen, golodirsen, casimersen, viltolarsen)Defines prior authorization, medical necessity, dosing, monitoring, billing, and coverage criteria for exon-skipping antisense oligonucleotide therapies for patients with Duchenne muscular dystrophy (DMD) within Healthfirst plans.All Healthfirst updates
Tool Description
Search Healthfirstprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
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Prior Authorization by Payer
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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