What types of policy changes does HealthPartners issue?

HealthPartners regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does HealthPartners update its policies?

HealthPartners typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many HealthPartners policy changes are tracked here?

This page currently tracks 19 documented HealthPartners policy changes. New items are added as they are identified.

What should I do when HealthPartners changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

HealthPartners Policy Changes & Prior Auth Updates

We track 19 documented policy changes from HealthPartners across IA, MN, ND, SD, WI. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original HealthPartners notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new HealthPartners updates automatically.

Medium impact
Fast Facts Newsletter - January 2025
HealthPartners·Effective Jan 1, 2025
HealthPartners has updated multiple administrative requirements including provider directory verification processes, new EIDBI behavior analyst licensing requirements effective January 1, 2025, and new reimbursement policies for intraoperative neuromonitoring and MHCP services effective March 1, 2025.
Medium impact
Fast Facts Newsletter - February (Special Edition) 2025
HealthPartners·Effective Apr 1, 2025
HealthPartners is implementing multiple pharmacy formulary changes including removing Promacta from commercial formulary (Alvaiz preferred), adding prior authorization requirements for 12 Medicare medications, and updating weight loss surgery coverage criteria effective April 1, 2025.
Medium impact
Fast Facts Newsletter - March 2025
HealthPartners·Effective May 1, 2025
HealthPartners released their March 2025 newsletter with multiple policy updates including new syphilis screening recommendations, provider directory verification requirements, and several new reimbursement policies effective 5/1/2025 covering observation care, modifier 22 procedures, and intensive outpatient programs.
Medium impact
Fast Facts Newsletter - April (Special Edition) 2025
HealthPartners·Effective Jun 1, 2025
HealthPartners is withdrawing Ranibizumab (Cimerli) from market on March 31, 2025, but patients can switch to Lucentis or Byooviz without new prior authorization. Additionally, 18 Cohere Health medical policies for various procedures will be revised effective June 1, 2025.
Medium impact
Fast Facts Newsletter - May 2025
HealthPartners·Effective Jul 1, 2025
HealthPartners issued a May 2025 newsletter with multiple new reimbursement policies effective July 1, 2025, covering laboratory services, ultrasounds, radiation therapy, care management, high-cost drugs, and add-on code G2211. The newsletter also includes new syphilis screening recommendations and administrative updates for provider directory verification.
High impact
Fast Facts Newsletter - June (Special Edition) 2025
HealthPartners·Effective Aug 1, 2025
HealthPartners is implementing new prior authorization requirements for advanced imaging services (CT, CTA, MRA, MRI, PET) through Cohere Health effective August 1, 2025, and adding new psychotherapy services reimbursement policies. Weight loss medication PA criteria are also being updated with stricter documentation requirements.
High impact
Fast Facts Newsletter - July 2025
HealthPartners·Effective Jul 1, 2025
HealthPartners updated reimbursement policies effective July 1, 2025, including changes to inpatient readmission criteria (30-day threshold for Commercial plans) and new restrictions requiring Medicaid/MinnesotaCare members to use only in-network laboratories except for urgent/emergent cases. Providers must now exclusively refer these members to contracted labs or face contract termination.
Low impact
Fast Facts Newsletter - July (Special Edition) 2025
HealthPartners·Identified Jun 19, 2026
HealthPartners has released a health equity special edition newsletter highlighting Community Health Workers (CHWs) services covered under Medicaid, vaccination resources, and tools to improve culturally responsive care. This is primarily informational guidance to help providers better serve diverse patient populations.
Medium impact
Fast Facts Newsletter - August (Special Edition) 2025
HealthPartners·Effective Oct 1, 2025
HealthPartners has updated their drug formulary with immediate changes affecting HIV PrEP/PEP medications, overactive bladder treatments, and medical policies for skilled nursing facilities and various procedures. Key changes include removing prior authorization for Descovy, formulary adjustments for Myrbetriq and Gemtesa, and new coverage criteria for specialized procedures effective October 1, 2025.
High impact
Fast Facts Newsletter - September 2025
HealthPartners·Effective Sep 1, 2025
HealthPartners has retired several medical policies effective immediately including hip and knee joint replacement surgery, updated allergy testing policy to exclude home-administered immunotherapy starting November 1, 2025, and revised ambulance/medical transportation policy requiring prior authorization only for non-emergency fixed wing air ambulance effective November 1, 2025.
Medium impact
Fast Facts Newsletter - October (Special Edition) 2025
HealthPartners·Effective Jan 1, 2026
HealthPartners is removing Humira and Hadlima from their commercial and Medicare formularies effective January 1, 2026, replacing them with preferred biosimilar alternatives. Prior authorizations will automatically transfer to the new preferred biosimilars for existing patients.
High impact
Fast Facts Newsletter - November 2025
HealthPartners·Effective Jan 1, 2026
HealthPartners updated two reimbursement policies effective January 1, 2026: Observation Level of Care policy now considers less than 2-day inpatient stays as observation and removes 'for specified diagnoses' restriction; Laboratory Services policy now excludes PLA codes from reimbursement.
High impact
Fast Facts Newsletter - December (Special Edition) 2025
HealthPartners·Effective Feb 1, 2026
HealthPartners is implementing a new refund recovery process that will show credit balances on provider accounts and generate Negative Vendor letters instead of standard remits. Multiple medical policy updates take effect immediately or February 1, 2026, including changes to SNF criteria, inpatient care guidelines, and various coverage policies.
Medium impact
Fast Facts Newsletter - January 2026
HealthPartners·Effective Jan 1, 2026
HealthPartners January 2026 newsletter includes multiple policy updates: several medical services added to non-covered/investigational list, surgical treatments for lipedema/lymphedema criteria updated for clarity, and waterjet ablation for BPH no longer requires prior medication trial.
High impact
Fast Facts Newsletter - February (Special Edition) 2026
HealthPartners·Effective Apr 1, 2026
HealthPartners is implementing multiple prior authorization requirements and formulary changes effective April 1, 2026, including new PA requirements for somatostatin analogs (previously no PA required for Sandostatin), oncology drugs like Vabrinty and Kyxata, and removal of Ventolin from formulary favoring generic albuterol. Several Medicare Part B drugs are now designated as non-preferred requiring step therapy.
Medium impact
Fast Facts Newsletter - March 2026
HealthPartners·Effective Mar 1, 2026
HealthPartners has enhanced their prior authorization requirements tool with more accurate results sorted by line of business, clearer explanations when no authorization is required, and added genetic testing authorization requirements. Multiple medical policies have been revised including changes to artificial intervertebral disc replacement coverage and new prior authorization requirements for certain Medicaid orthotics effective May 1, 2026.
Medium impact
Fast Facts Newsletter - April (Special Edition) 2026
HealthPartners·Effective Apr 1, 2026
HealthPartners has made multiple policy changes effective immediately and June 1, 2026, including retiring reconstructive surgery policy, adding new investigational services as non-covered, updating home health criteria to use InterQual standards, and revising arthroplasty policies for all plan types.
High impact
Fast Facts Newsletter - May 2026
HealthPartners·Effective Jul 1, 2026
HealthPartners updated multiple medical policy coverage criteria effective July 1, 2026, including new coverage for specialty testing in urology, expanded endocrinology testing coverage, and revised oncology testing criteria. The policy also includes administrative updates for provider directory information and cultural competency requirements.
Medium impact
Fast Facts Newsletter - June (Special Edition) 2026
HealthPartners·Effective Aug 1, 2026
HealthPartners has updated multiple medical policies effective immediately and August 1, 2026, including expanded cardiac monitoring coverage, new prior authorization requirements for prosthetic devices, consolidated nutritional support policies, and new reimbursement policies for single-dose vial billing and 3D imaging services.

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Fast Facts Newsletter - January 2025

Fast Facts Newsletter - February (Special Edition) 2025

Fast Facts Newsletter - March 2025

Fast Facts Newsletter - April (Special Edition) 2025

Fast Facts Newsletter - May 2025

Fast Facts Newsletter - June (Special Edition) 2025

Fast Facts Newsletter - July 2025

Fast Facts Newsletter - July (Special Edition) 2025

Fast Facts Newsletter - August (Special Edition) 2025

Fast Facts Newsletter - September 2025

Fast Facts Newsletter - October (Special Edition) 2025

Fast Facts Newsletter - November 2025

Fast Facts Newsletter - December (Special Edition) 2025

Fast Facts Newsletter - January 2026

Fast Facts Newsletter - February (Special Edition) 2026

Fast Facts Newsletter - March 2026

Fast Facts Newsletter - April (Special Edition) 2026

Fast Facts Newsletter - May 2026

Fast Facts Newsletter - June (Special Edition) 2026