Medicare AdvantageAdministrativeMedium impact
Reminder regarding members who seek mental health or substance abuse services
Healthfirst·Psychiatry, Family Medicine, Internal Medicine +1 more·Provider Update
We identified it
Jun 20, 2026
Summary
Healthfirst members seeking mental health or substance abuse services from contracted providers do not require a PCP referral. This clarifies referral requirements for behavioral health services and may reduce administrative burden for these claims.
Action Required
Immediately: Billing team should verify that Healthfirst behavioral health claims are not being held for PCP referrals. Update billing system rules to exclude referral requirements for mental health and substance abuse services for Healthfirst members. Front desk staff should stop requesting PCP referrals for these services.