Summary
HealthPartners' November 2026 Fast Facts newsletter lists several changes, most effective January 1, 2027: Cigna-insured members will require precertification for outpatient non-emergency CT, MRI and PET imaging; manual and power mobility device codes will require prior authorization for Medicare Advantage, Medicare Cost and MSHO members; Actemra is being replaced by the biosimilar Avtozma and several diabetes and insulin drugs are leaving the formulary; and Minnesota Medicaid moves to MNAAC pharmacy reimbursement. The billing team should also note the standing reminder to submit any change to a previously filed claim as a corrected claim with Bill Frequency Code 7.
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What to do
Action · 8 steps
01By 2027-01-01: For Cigna insured members, get eviCore precertification before scheduling outpatient non-emergency CT, CT angiography, MRI, MRA and PET imaging (not required for inpatient, emergency room or 23-hour observation services).
02Billing team: confirm precertification numbers are captured in the prior auth tracker and on the claim.
03Before 2027-01-01 for Medicare Advantage, Medicare Cost and MSHO members: obtain prior authorization before ordering or dispensing the listed manual and power mobility device codes, and update charge entry and front desk scheduling workflows so orders are held until authorization is on file.
04Also by 2027-01-01: update the Actemra claim and formulary references to Avtozma, and check the formulary at healthpartners.com/formularies for Jardiance, Synjardy, Glyxambi, Novolin and Contrave.
05Minnesota Medicaid pharmacy billing: review the MNAAC pricing change and tell pharmacy and front desk staff members may see different cost-sharing.
06Ongoing: when a previously submitted claim needs any change, submit it as a corrected claim with Bill Frequency Code 7 referencing the original claim number, because submitting it as a new original may cause duplicate denials or payment delays.
07Tell providers and front desk staff about the Focus-to-Achieve network transition and the Medicare Advantage plan closures.
08Check current applicability of all dates against the current HealthPartners publication, since this analysis is based solely on the November 2026 newsletter.
Codes mentioned
K0013E2310E2311E2230K0001K0002K0003K0004K0005K0006K0007K0009E1161E1229E1231E1232E1233E1234E1235E1236E1237E1238K0899K0800K0801K0802K0806K0807K0808K0812E2298E2301E1002E1003E1004E1005E1006E1007E1008K0813K0814K0815K0816K0820K0821K0822K0823K0824K0825K0826K0827K0828K0829K0830K0831K0835K0836K0837K0838K0839K0840K0841K0842K0843K0848K0849K0850K0851K0852K0853K0854K0855K0856K0857K0858K0859K0860K0861K0862K0863K0864K0868K0869K0870K0871K0877K0878K0879K0880K0884K0885K0886K0890K0891K0898E2331E1037E1038E1039K0108C1607E0735E0721A4543
Original notice
Fast Facts Newsletter - November 2026
healthpartners.com · Always check the source before changing claims.
Related changes
See all HealthPartners changes →Fast Facts Newsletter - August (Special Edition) 2026MediumEffective Oct 1, 2026 · PharmacyFast Facts Newsletter - July 2025HighNo effective date · PharmacyFast Facts Newsletter - January 2025HighNo effective date · Medical PolicyFast Facts Newsletter - March 2025MediumEffective May 1, 2025 · Medical PolicyBrowse every HealthPartners change in the policy list
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