CommercialAdministrativeMedium impact
Provider Alert: Behavioral Health Utilization Review Implementation
Healthfirst·NY · Psychiatry, Family Medicine, Internal Medicine +1 more·Provider Update
Effective date
Feb 6, 2023
We identified it
Jun 20, 2026
Summary
Healthfirst has implemented a new trigger-based utilization review process for acute mental health services across all health plans except Medicare Advantage plans, effective February 6, 2023. This change was mandated by the New York State Office of Mental Health and affects how behavioral health services are reviewed and approved.
Action Required
Immediately: Billing team should review current behavioral health claims processes for Healthfirst members (excluding Medicare Advantage). Contact Healthfirst for specific details on the new trigger-based utilization review requirements and update internal workflows accordingly. Monitor for potential delays or denials in behavioral health claims processing.