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Have any questions?

Healthfirst
100 Church Street
New York, NY 10007

Want to become a Healthfirst member? Have a question about our benefits?
Contact us at:

Medicaid, Child Health Plus, and Family Health Plus
1-866-463-6743

Medicare
1-877-237-1303
TDD/TTY English
1-888-542-3821
TDD/TTY Español
1-888-867-4132
Monday-Friday, 8:30 am to 6 pm

Already a Healthfirst member? For answers to your questions, contact us at:

Medicaid, Child Health Plus, and Family Health Plus
1-866-463-6743
Monday - Friday, 8 am to 6 pm

Medicare
1-888-260-1010
TDD/TTY English
1-888-542-3821
TDD/TTY Español
1-888-867-4132
Monday - Sunday, 8 am to 8 pm


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Provider Forms

Your job is complex enough without having to hunt for forms. Healthfirst makes it simple – by putting all your authorization and request forms in one location.


Downloadable Forms
Below you can find the most up-to-date versions of all relevant authorization and request forms.

Block Vision Authorization Form PDF icon image
Healthfirst Global Prescription Exception Form for NY Medicaid PDF icon image
External Appeals Application Instructions PDF icon image
External Appeals Application PDF icon image
Emergent Admission Fax Form PDF icon image
Medical Request for Home Care Form PDF icon image
CareCore Clinical Notes Needed Fax PDF icon image
CareCore PET Scan Certification Form PDF icon image
Request for Outpatient Authorization   PDF icon image
Hospital Discharge Process PDF icon image
Submitting Medical Necessity Data for Non-Urgent Services PDF icon image

 

Last update 2013-04-04 16:30