Administrative policies

Administrative policies are available for providers delivering care to HealthPartners members.

1. Access to Care & Services
2. Access to Doula Services During Pregnant People
3. Accessibility to Utilization Mgmt Staff
4. Advance Notice of Non-Coverage for Medicare members
5. Affirmative Statement Regarding Incentives
6. Care Coordination for MSHO/MSC+
7. CIGNA/HealthPartners Alliance
8. Clinical Practice Guidelines
9. Complaint Reporting
10. Continuity of Care Due to Employer Change in Health Plans
11. Continuity of Care Following Termination of a Provider
12. Coordination of Care, Provider Responsibility
13. Credentialing Notifications
14. Delegation Oversight for Care Coordination
15. Designated ARMHS Network Participation Criteria
16. Designated EIDBI Network Participation Standards
17. Disease and Case Management Services(Commercial Products)
18. Disease and Case Management Services(Medicaid and Medicare Products)
19. Do Not Use Abbreviations & Error-prone Abbreviations
20. Enrollee Rights - Minnesota Health Care Programs
21. Essential Community Provider Contracts
22. Home Care Bill of Rights–Minnesota Health Care Program
23. Hospital Admission Notification Process
24. Hospital, SNF, HHA, and CORF Notifications to Medicare Members
25. Imaging Accreditation
26. Intensive Obesity Counseling
27. Measuring and Reporting Provider Performance
28. Medical Records Standards
29. Medicare Responsibilities for Providers and HealthPartners
30. Medication Therapy Management (MTM) Provider Participation Criteria
31. Member Appeals Process for Public Programs
32. Member Rights and Responsibilities
33. Network Adequacy Request – Benefit Review
34. Network Responsiveness
35. Offshore Attestation
36. Oncology Care Program Standards
37. Patient-Provider Communication
38. Pediatric Vision – HP Eyewear Collection
39. Personal Care Assistance & Elderly Waiver Provider Requirements
40. Physician Incentive Plan (PIP) Data and Surveys
41. Practitioner Office Site Quality
42. Preventing, Detecting & Reporting Fraud, Waste & Abuse
43. Prescription Monitoring Program (PMP)
44. Prior Authorization Review Process for Commercial Products
45. Prior Authorization Review Process for Medicare Products
46. Prior Authorization Review Process for Medicaid Products
47. Privacy Practices for Contracted Network Providers
48. Provider Billing and Collection of Member Cost-Sharing for Medicaid Products
49. Provider Communications
50. Provider-Initiated Clinic Reassignment of Member
51. Quality Case Reviews
52. Quality Monitoring of Organizational Providers
53. Rare Diseases or Conditions
54. Referral Management: Provider Recommendation for Further Services
55. Required Disclosure to Patients of Potential Bills from Providers
56. Specialty Pharmacy Network Participation Requirements
57. Standing Referral Process
58. Total Cost of Care and Patient Management Data Use
59. Transition of Care When Benefits End
60. Utilization Management Criteria Access

Reimbursement Policies

1. Add-On Code G2211
2. Anesthesia Payment Methodology
3. Anti-Fraud, Waste, and Abuse Expectations
4. Bundled Invasive Procedures in Ambulatory Surgery Center Settings
5. Claim Submission Requirements for Drug Codes
6. Critical Care Services When Patient is Discharged to Home
7. Diagnosis Coding Edits for Acute Stroke and Sepsis
8. Fixed Wing Air or Rotary Wing Air Ambulance Transportation Provider Reimbursement
9. GA Modifier on Claim Submissions
10. GA, GY, or GZ Modifier on Claim Submissions for Medicare Plans
11. Genetic & Molecular Lab Testing
12. High-Cost Medical Drugs
13. Intraoperative Neuromonitoring
14. Inpatient Hospital Readmissions
15. Intensive Outpatient Programs (IOP)
16. Interpreter Services
17. Laboratory Services
18. Minnesota Care Tax
19. Modifier 22 Procedures
20. Multiple Procedure Payment Reduction (MPPR) Rules-Facility Claims
21. Multiple Procedure Payment Reduction (MPPR) Rules-Professional Claims
22. Never Events
23. Provider-Based Care Management Services
24. Psychotherapy Services
25. Reimbursement at Observation Level of Care
26. Reimbursement of services provided to Minnesota Health Care Programs (MHCP) enrollees
27. Reimbursement for Services Provided by Pre-licensed Practitioners and Postdoctoral Fellows
28. Services Incidental to Inpatient Stay
29. Self-administered Drugs Requiring Claim Submission on the Pharmacy Benefit
30. Single Dosed Vial Billing Requirements
31. Spravato® (esketamine)
32. Superficial Radiation Therapy
33. Technology Enabled Surgical Procedures
34. Telehealth Services
35. Three-Dimensional (3D) Imaging Services
36. Transabdominal, Transvaginal Ultrasounds
37. Use of GK and GA Modifier on Claim Submissions for Hearing Aids