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Provider Resources

Policies and Forms

Network Health's policies are reviewed and updated annually. It is your responsibility to check this page often for new and/or revised policy changes.

Medicare Policies and Forms

We have collected information related to our Medicare processes, policies and procedures into one reference page called the Provider Medicare Manual.

Authorization Lists and Forms

Review authorization submission and response timelines, find listed services that require prior authorization for general medicine, pharmacy, genetic testing and experimental or investigational services. 

Medicare Plans
Commercial Plans




Preventive Services Guide

In addition to an annual wellness visit, Network Health covers other preventive services at no cost for most of our members when they visit doctors within our provider network. Network Health follows the recommendations of the United States Preventive Services Task Force (USPSTF).

Commercial Preventive Services Guide

Appeals and Grievances Policies and Forms

For more information on the grievance process as well as member rights and responsibilities, please visit our legal page

Commercial Grievance Form
Medicare Appeal Request Form
Grievance and Appeals Resolution Policy and Procedure
for Medicare Advantage Plans Part D

Grievance and Appeals Resolution Policy and Procedure
for Medicare Advantage Plans Part C  
Non-Contract Provider Claim Appeals (Medicare)

Waiver of Liability Form
Member Appeals Document
Reopening and Peer to Peer (P2P) Process Document



Credentialing Policies and Procedures

View policies and procedures related to credentialing, recredentialing and provider data maintenance for contracted providers.  


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