All PlansPrior AuthMedium impact
Updated Healthfirst Policy for the Authorization of Applied Behavioral Analysis (ABA) Services
Healthfirst·Pediatrics, Psychiatry·Prior Authorization
We identified it
Jul 8, 2026
Summary
Healthfirst has updated medical necessity criteria for Applied Behavioral Analysis (ABA) services requiring prior authorization. Billing teams must contact Healthfirst Provider Services to obtain the specific updated criteria and implement new authorization requirements for ABA claims.
Action Required
Immediately: Billing team must contact Healthfirst Provider Services at 1-888-801-1660 (Monday–Friday, 8:30am–5:30pm) to obtain the complete updated ABA medical necessity criteria. Once received, update prior authorization procedures in the billing system to reflect new criteria. Ensure all ABA service requests are submitted with documentation meeting the updated medical necessity standards. Claims submitted without adherence to updated criteria may be denied. Front office staff should flag all ABA referrals for prior authorization review before scheduling.