MedicaidCoverageHigh impact
Fast Facts Newsletter - July 2025
HealthPartners·MN·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
HealthPartners updated reimbursement policies effective July 1, 2025, including changes to inpatient readmission criteria (30-day threshold for Commercial plans) and new restrictions requiring Medicaid/MinnesotaCare members to use only in-network laboratories except for urgent/emergent cases. Providers must now exclusively refer these members to contracted labs or face contract termination.
Action Required
Immediately: Billing team must verify laboratory network status before ordering any lab services for Medicaid/MinnesotaCare members. Contact HealthPartners provider relations to obtain list of contracted laboratory providers. Update referral processes to ensure all non-urgent lab work goes to in-network labs only. Out-of-network lab claims will be denied and cannot be billed to members. Failure to comply may result in contract termination.