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 prioritize providing 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 and 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]
View Sample Member ID cards for help identifying patient plan types and benefits.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Find links to frequently used forms.
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.
Find links to helpful training tools for our providers. Here you will also find a recording and orientation PowerPoint to help navigate our provider portal.
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.