All PlansReimbursementHigh impact
Fast Facts Newsletter - November 2025
HealthPartners·MN, WI·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
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.
Action Required
By January 1, 2026: Billing team must update system logic to flag inpatient stays less than 2 days for potential observation level billing review. Update laboratory billing to exclude PLA (Proprietary Laboratory Analyses) codes as non-reimbursable. Review current observation billing criteria and remove diagnosis-specific restrictions. Train staff on expanded observation criteria and updated appeals process.