CommercialPrior AuthMedium impact
Behavioral Health UR Implementation
Healthfirst·NY · Psychiatry·Provider Update
Effective date
Feb 6, 2023
We identified it
Jun 20, 2026
Summary
Healthfirst has implemented a new trigger-based utilization review (UR) process for acute mental health services that affects all health plans except Medicare Advantage plans, effective February 6, 2023. This change requires different prior authorization or review procedures for behavioral health services.
Action Required
Immediately: Billing team must review the full policy details at the provided URL to understand new trigger-based UR requirements for acute mental health services. Update billing workflows to comply with new utilization review procedures for Healthfirst plans (excluding Medicare Advantage). Contact Healthfirst for specific trigger criteria and authorization requirements.