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HealthPartnersCommercial · Coverage · Pharmacy · MN · Pharmacy, Oncology, Hematology +2 moreMedium impact

Fast Facts Newsletter - July 2025

Effective date
Jul 1, 2025
Identified
Nov 6, 2026

Summary

HealthPartners' July 2025 Fast Facts newsletter (historical; first detected 2026-11-06) lists several provider-facing items: a 7/1/2025 updated Laboratory Services policy that, for Medicaid and MinnesotaCare members, says non-urgent out-of-network lab services are not covered and must be referred to in-network labs, a 7/1/2025 Inpatient Readmission policy update (30-day threshold), numerous medical and pharmacy coverage policy revisions Reported as already effective in the historical source, a reconstructive surgery criteria change effective 09/01/2025, and formulary removals of long-acting G-CSF products from the pharmacy benefit with updates posted by 9/1/25. Because the issue is from July 2025, confirm on HealthPartners' site whether each item still applies before acting.

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What to do

Action · 6 steps
01Historical material (issue dated 2025-07-01; the 7/1/2025 effective dates and the 9/1/25 posting date have already elapsed as of 2026-11-06, so confirm current status with HealthPartners rather than completing them as new deadlines).
02Billing team: for Minnesota Medicaid and MinnesotaCare members, verify that lab orders go to HealthPartners in-network laboratories before billing, and confirm the lab's network status with providers; if a lab is out of network, the source states such non-urgent services will not be covered for those members, so do not bill the member for them.
03Providers and front desk staff should be told to check lab network status before ordering.
04For reconstructive surgery claims, update coverage-criteria checklists so documentation supports the functional-deficit language (effective 09/01/2025 per the source).
05For Commercial, MHCP and Medicare pharmacy and medical-benefit claims involving long-acting G-CSF (Fulphila, Neulasta, Ziextenzo, and the medical-benefit listing), confirm the product is billed under the medical benefit rather than pharmacy claims.
06Also confirm the provider directory and cultural competency/ADA questionnaire information is current in Provider Data Profiles, and enable MFA on the provider portal as the source describes for later in 2025.

Codes mentioned

J7171

Original notice

Fast Facts Newsletter - July 2025
healthpartners.com · Always check the source before changing claims.
View original ↗

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