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Administrative policies

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

  1. Access to Care & Services
  2. Access to Doula Services for 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. Diagnostic Imaging Provider Notification Program
  16. Disease and Case Management Services(Commercial Products)
  17. Disease and Case Management Services(Medicaid and Medicare Products)
  18. Do Not Use Abbreviations & Error-prone Abbreviations
  19. Enrollee Rights - Minnesota Health Care Programs
  20. Essential Community Provider Contracts
  21. Equity, Inclusion, & Anti-Racism
  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. Offshore Attestation
  35. Oncology Care Program Standards
  36. Patient-Provider Communication
  37. Pediatric Vision – HP Eyewear Collection
  38. Personal Care Assistance & Elderly Waiver Provider Requirements
  39. Physician Incentive Plan (PIP) Data and Surveys
  40. Practitioner Office Site Quality
  41. Practice Requirements for Network EIDBI Providers
  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. Bundled Invasive Procedures in Ambulatory Surgery Center Settings
  4. Claim Submission Requirements for Drug Codes
  5. Fixed Wing Air or Rotary Wing Air Ambulance Transportation Provider Reimbursement
  6. GA Modifier on Claim Submissions
  7. GA, GY, or GZ Modifier on Claim Submissions for Medicare Plans
  8. Genetic & Molecular Lab Testing
  9. High-Cost Medical Drugs
  10. Intraoperative Neuromonitoring
  11. Inpatient Hospital Readmissions
  12. Intensive Outpatient Programs (IOP)
  13. Interpreter Services
  14. Laboratory Services
  15. Minnesota Care Tax
  16. Modifier 22 Procedures
  17. Multiple Procedure Payment Reduction (MPPR) Rules-Facility Claims
  18. Multiple Procedure Payment Reduction (MPPR) Rules-Professional Claims
  19. Never Events
  20. Provider-Based Care Management Services
  21. Psychotherapy Services
  22. Reimbursement at Observation Level of Care for Specified Diagnoses
  23. Reimbursement of services provided to Minnesota Health Care Programs (MHCP) enrollees
  24. Reimbursement for Services Provided by Pre-licensed Practitioners and Postdoctoral Fellows
  25. Robotic Assisted Surgical Services
  26. Services Incidental to Inpatient Stay
  27. Self-administered Drugs Requiring Claim Submission on the Pharmacy Benefit
  28. Spravato® (esketamine)
  29. Superficial Radiation Therapy
  30. Transabdominal, Transvaginal Ultrasounds
  31. Telehealth Services
  32. Use of GK and GA Modifier on Claim Submissions for Hearing Aids