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Provider Resources

Claims Resources

Claims Submission and Reimbursement

Network Health’s goal is to process all claims at initial submission. Before we can process a claim, however, it must be a “clean” or complete claim submission. If any of the necessary information is missing from the claim, we will not be able to process your claim in a timely fashion.

To facilitate the timely processing of your claims, please follow the claims procedures and polices provided. 

Claims Policies and Procedures

Mail claims to: Network Health, P.O. Box 568, Menasha, WI 54952

Claims Appeal Processes

If you receive a denied claim from Network Health, please review the denial message printed on your provider remittance advice. If you have questions regarding the denial, please contact the member experience team. You may dispute the denial by completing the provider dispute form located on Network Health’s Provider Portal.

Member Experience Team Phone Numbers:

Medicare
 Group
 Individual and Family
800-378-5234
or
920-720-1345
800-826-0940
or
920-720-1300
855-275-1400
or 
920-720-1400

Provider Appeals/Dispute Timeframes:

Commercial claims: Participating and Non-Participating providers have 120 days to submit a payment dispute.

Medicare claims: Participating providers have 120 days to submit a dispute. Non-Participating providers have 120 days to submit a dispute and  60 days to file an appeal (claim denial).

     Non-Participating Provider Appeals

All timeframes start with the original remittance advice date. All payment dispute decisions are final. 

 

To submit a payment dispute: Log into the Provider Portal, select the Claims tab (located on the navigation bar to the right), then from the drop down select Claims Dispute Form.

 Provider Portal Log In

View and Edit Claims 

Claims Rejection Reports in Provider Portal

To see if your claim has been rejected due to missing or inaccurate information, log into the provider portal to access your claims rejection report. 

Additional Resources
Specialty Code Listing for Claims Editing

Change Healthcare Provider Electronic Fund Transfer (EFT)

Receive EFT payments through Change Healthcare for services provided to patients.
Use the payor identification numbers listed below.

  • Commercial - 39144
  • Medicare - 77076

How to Enroll or Make Changes

New enrollment and changes to enrollment can be done by choosing one of the links below or by calling 866-506-2830. 

EFT Enrollment Process

Step One: Information is submitted by the provider and a signature page is provided (e-signature, fax or mail).
Step Two: An email is sent to the provider with a test deposit detail and Payment Manager login information.
Step Three: The provider validates the test deposit and final setup is completed.

The entire EFT setup process can take up to two weeks depending on information received.

Other Tools Available

Once enrolled, access these other useful tools. 

  • Provider Self Registration Application (PSR) – Allows you to maintain/update your bank information and payer selection for EFT
  • Payment Manager – Used for remittance searching, viewing, printing and downloading your 835s

EyeMed Information

For more information about EyeMed vision claims see EyeMed's Professional Provider Manual


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.