Provider Resources

Welcome Providers

At Network Health, our mission is to enhance the life, health and wellness of the people we serve. Our relationship with providers plays a vital role in that mission, so we make it a priority to provide you and your staff with tools to streamline the process of serving our members.

This online toolkit includes a collection of valuable resources.

Reminder - Use ESI Care Continuum (CCUM) for Faster Medical Drug Prior Authorization

Network Health has partnered with ESI Care Continuum (CCUM) for medical drug prior authorizations. CCUM handles pre-determination and prior authorization requests for medical drug (excluding oncology drug) for all lines of business, including Medicare and Health Exchange. eviCore will continue to review oncology medical drug requests.

Submit drug requests in the CCUM ExpressPAth portal, available 24 hours a day, seven days a week, through seamless access in the Network Health provider portal. 

Learn more about ESI Care Continuum on the Authorization Information page.

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 initial submission. We provide access to claims procedures and policies to help facilitate the timely processing of submissions. You will also find information about the claims dispute process, provider appeals and claims action requests.

Policies and Forms

Network Health reviews and updates commercial, Medicare and general medical policies regularly. We encourage you to visit this section often for policy changes. You will also find links to frequently used forms.

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.

News and Announcements

Check out our monthly provider enewsletters. 
The Pulse helps you stay up-to-date on the latest news, trends and operations updates.
The Consult 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 quarterly newsletter produced by the Network Health pharmacy department, informs providers of current and upcoming pharmacy-related news. 

 

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. 

Credentialing 

The credentialing process plays a vital role in providing safe, quality patient care to our members. Our credentialing department evaluates the qualifications of providers who wish to become affiliated with Network Health.

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.

Wellness Programs

Learn more about Network Health’s programs for members, including Care Management, Condition Management and Member Wellness. Refer patients to take advantage of these programs for better health outcomes and overall wellness.

Provider Medicare Manual

Find all materials related to Medicare in one place—authorization lists, claims resources, Medicare plan materials, benefits information and more can be found in this online reference manual.

Inovalon Overview

Network Health uses the services of Inovalon to help address opportunities in the health of our Medicare Advantage and Affordable Care Act (ACA) members. Initiatives, like the Inovalon partnership, complement the efforts of providers to improve the overall health of our members by evaluating current health conditions and applying additional strategies to close gaps in care.

Health Insurance Exchange (HIX) Information

Find answers to frequently asked questions about provider networks, grace periods and more. 


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.