Network Health 2024 Medicare Advantage PPO plans are rated 5 out of 5 stars by Medicare. Learn more.

Provider Resources



We are currently experiencing longer hold times for the provider phone line.

Please consider using the provider portal to access information and resources.

Portal Login


Due to a continuing nationwide service outage, explanation of benefits (EOB), real-time eligibility verification process, claims submission, claims remittance advice and claims payments to providers are not working properly. This temporary disruption does not affect prior authorizations and pharmacy.

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Welcome Providers

At Network Health, our mission is to create healthy and strong Wisconsin communities. Our relationship with providers plays a vital role in that mission, so we make it a priority to provide you and your staff with helpful tools to streamline the process of serving our members.

Each of our participating provider partners is assigned a designated provider operations manager. The provider operations manager is your contact for questions related to the contract, helps resolve provider appeals/disputes and claims/payment issues, provider portal training and education on current and new payment policy and procedures. The team is available for in-person visits, as well as phone calls via Microsoft Teams. Please see the contact information below.

Melissa Anderson, Director of Provider Operations [email protected]
Jill Stoken, Manager of Contract Operations [email protected]
Natalie Knaack, Provider Operations Manager [email protected]
Sarah Knutson, Provider Operations Manager [email protected]
Kitty Plowman, Provider Operations Manager [email protected]

Provider Reference Guide

View Sample Member ID cards for help identifying patient plan types and benefits. 

Provider Portal Access

Registered providers have access to view patient eligibility, check status of claims, submit online authorizations and more. Registration is now available for both contracted and non-contracted providers. Sign up now.

Authorization Information

Network Health uses online authorization systems to streamline communication and improve turnaround times for submissions. Learn more about iExchange, eviCore and ESI Care Continuum. Find resources such as tutorials, authorization lists, FAQs and member ID card explanations.  

Claims Resources

Our goal is to process all claims at the initial submission. Find information related to how to submit a claim, appeal/dispute process, claim rejection report and provider payment options.

Fraud, Waste, Abuse and Audits

Network Health is committed to preventing, detecting, and deterring Fraud, Waste, and Abuse. Find links to our policies and procedures to comply with federal, state, and regulatory requirements.

Medicare Plan Materials

View plan documents to learn more about Medicare member benefits and member cost share. You can find links to information about this year’s and last year’s Medicare plans.

Member Appeal and Grievance Process and Forms

Find links to forms as well as policy and procedure information. For more information on the grievance process, as well as member rights and responsibilities, please visit our legal page.

Policies

Network Health reviews and updates commercial, Medicare and general medical policies regularly. Find information related to Network Health's payment, credentialling, general and medical policies. We encourage you to visit this section often for policy changes.

Pharmacy Information

Network Health manages prescription drug plan formularies for commercial, exchange and Medicare plans. We provide information and resources to help you navigate the subtle differences in tier structures, utilization management rules and other requirements or restrictions.

Become a Contracted Provider

If you’re looking for the biggest health plan in the nation, that’s not us. We are careful when selecting our provider partners—we look for those who are the best at what they do and bring value to our network. Read more to see if Network Health is the place for you. 

Forms

Find links to frequently used forms.

Quality Health Integration

Network Health collaborates with providers to ensure members receive the highest quality care. Review clinical practice guidelines, learn more about quality measures and rankings (NCQA, HEDIS, CAHPS) and find resources and tools to meet quality goals.

Training

Find links to helpful training tools for our providers. Here you will also find a recording and orientation power point to help navigate our provider portal.

News and Announcements

Check out our provider enewsletters. 
The Pulse helps you stay up-to-date on the latest news, trends and operations updates.
The Consult,a bimonthly newsletter tells you about our member programs designed to close care gaps and initiatives around specific quality measures, and shares highlights from our health management teams and network providers.
The Script, a bimonthly newsletter produced by the Network Health pharmacy department, informs providers of current and upcoming pharmacy-related news. 

 


Network Health
1570 Midway Place
Menasha, WI 54952
Hours
Mon., Wed.-Fri.: 8 a.m. to 5 p.m.
Tuesday: 8 a.m. to 4 p.m.

COVID-19 Information for Network Health Members

Learn more about the recent Change Healthcare breach.