All PlansPrior AuthMedium impact
Prior Authorization Required for Select Codes Starting April 1, 2026
Healthfirst·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
Starting April 1, 2026, select medical billing codes will require prior authorization before services can be rendered. This is a fresh policy update that will impact claim submission workflows and requires advance preparation by billing teams.
Action Required
Before April 1, 2026: Billing team must identify which specific codes will require prior authorization once the full policy details are released. Monitor the source URL for updates on affected codes. Prepare to update billing system settings and staff training materials. Notify providers that prior authorization workflows will change for select procedures.