Fast Facts Newsletter - July 2026

REQUIREMENTS: By 07/01/2026: - Billing team must update claim denial logic to remove CyPass micro-stent (aqueous drainage device) from any investigational/non-covered lists, as device is no longer commercially available. - Billing team must add the following procedures to non-covered/investigational lists: Irreversible electroporation (NanoKnife system), Synchronized diaphragmatic stimulation via implantable device (VisCardia VisONE system), and Translingual neurostimulation for gait/balance rehabilitation (Solana PoNS device). Claims for these services will be denied. - Billing team must update coverage rules to reflect that Ocular Albinism testing has moved from Dermatology to Ophthalmology policy. Route claims accordingly to correct medical director for pre-authorization review. - Retire Oncology testing policies for hereditary cancer and solid tumors molecular diagnostics (Minnesota Health Care Programs). Remove from coverage files immediately. Update billing software denial rules to reference investigational services policy instead. By 08/01/2026: - Billing team must update balloon sinuplasty (balloon sinus ostial dilation) prior authorization criteria to: (1) Remove requirement for prior antibiotic therapy, (2) Clarify that anterior or posterior nasal drainage must be mucopurulent, (3) Clarify CT findings must show complete or partial os obstruction. Update encounter templates and pre-auth screens to reflect new requirements. By 10/01/2026: - Billing team must update coverage for surgical treatments of lipedema and lymphedema to include direct excision/debulking as a covered indication. Update billing software to approve these procedures when medical necessity is documented. - Billing team must ensure surgical procedures performed for prevention of lipedema are flagged as non-covered and denials include specific language referencing prevention exclusion. Immediately (ongoing): - All billing and clinical staff must complete Provider Directory Cultural Competency and ADA Accessibility Questionnaire and return to providercompliance@healthpartners.com. Non-compliance may result in directory accuracy violations and network sanctions. - Billing team should begin monitoring provider portal for updates to Medical Policy list at Coverage criteria policies | HealthPartners and implement additional policy changes as they are released (several policies are listed as 'revised' with details cut off in document). - Billing team must test access to enhanced Claim Adjustments and Appeals application on provider portal (live as of 06/09/2026) to familiarize with new denial explanation functionality for faster processing.