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Fast Facts Newsletter - July 2026
Effective date
Not stated in the notice
Identified
Jul 1, 2026
Summary
Cohere Health coverage criteria for Commercial, Medicaid and Medicare Advantage plans are revised, and a new Omnibus Codes (Musculoskeletal Care and Pain Management) policy applies to services that require Cohere prior authorization, effective September 1, 2026. Prior authorization submissions made through the Cohere portal must include clinical documentation at the time of submission, and fax and phone submissions are unchanged. The Medicare GLP-1 Bridge program runs from July 1, 2026 through December 31, 2027, with CMS managing prior authorization, claims adjudication and payment to pharmacies for eligible Part D beneficiaries.
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What to do
Action · 16 steps
01Already effective September 1, 2026: Attach clinical documentation at the time of each prior authorization submission made in the Cohere portal.
02Review the revised Cohere policies for Commercial/Medicaid and Medicare Advantage plans on the HealthPartners Upcoming Policy Changes page, and contact the Medical Policy Intake line at 952-883-5724 for patient-specific inquiries.
03Include the rendering provider on claims for any code or service that requires a specific provider to be present and deliver the service.
04Claims submitted without the required rendering provider will be denied, and a denied claim must be resubmitted by the billing entity with the appropriate rendering provider information.
05Already effective August 1, 2026: For balloon sinus ostial dilation under the chronic rhinosinusitis and recurrent acute rhinosinusitis criteria, anterior or posterior nasal drainage must be mucopurulent, antibiotic therapy is no longer required, CT findings must show complete or partial ostial obstruction or opacification, and the requirement that sinonasal symptoms correspond to the CT findings was removed.
06Already effective October 1, 2026: For lipedema and lymphedema surgical treatment, direct excision or debulking is a covered indication for treatment, and surgical procedures performed to prevent lipedema are listed as not covered.
07Effective immediately: Mantle cell lymphoma MRD testing is medically necessary when the tumor is stage II or higher, TP53 negative, and the member is in complete remission following treatment completion.
08Irreversible electroporation (NanoKnife), synchronized diaphragmatic stimulation (VisONE) for heart failure, and translingual neurostimulation (PoNS) for gait or balance rehabilitation were added as non-covered or investigational.
09Ongoing from July 1, 2026 through December 31, 2027: For the Medicare GLP-1 Bridge, confirm Part D coverage and review prior authorization criteria before prescribing.
10If eligibility appears to be met, send the prescription to the patient's requested pharmacy, include an obesity diagnosis code (the E66 family), and indicate 'SEND TO BRIDGE FOR WEIGHT MANAGEMENT.' Submit authorization requests to CMS through its designated process, where provider attestation to coverage criteria is required and chart notes are not.
11An approved prior authorization remains effective until 12/31/27.
12A formulation change does not require a new prior authorization, but a change of drug does, and there are no appeals for the Bridge program.
13Already effective June 9, 2026: View denial details for appeals and adjustments in the Claim Adjustment and Appeals application on the provider portal, without waiting for a letter.
14Continue current admission and discharge notification processes until HealthPartners announces an implementation date for PointClickCare ADT notifications, since ADT notifications do not replace required prior authorization for LTACH, acute rehab and SNF admissions, or claims submission.
15Keep practitioner and location details current in Provider Data Profiles on the provider portal.
16Complete the Provider Directory Cultural Competency and ADA Accessibility Questionnaire for each office location annually and submit it to providercompliance@healthpartners.com or by fax to 952-853-8708.
Codes mentioned
E66
Original notice
Fast Facts Newsletter - July 2026
healthpartners.com · Always check the source before changing claims.
Related changes
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