All PlansPrior AuthMedium impact
Prior Authorization Required for Select Codes Starting July 1, 2026
Healthfirst·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
Starting July 1, 2026, prior authorization will be required for select billing codes. This is a fresh policy update that will impact claim submission workflows for affected procedures.
Action Required
By June 30, 2026: Billing team must identify which specific codes require prior authorization once the full policy details are released. Update billing system to flag affected codes for prior auth verification. Train staff on new prior authorization workflows. Failure to obtain required prior authorization will result in claim denials.