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, you should review the denial message printed on your remittance advice document or contact customer service for clarification. If you still have concerns about the claims and there are extenuating circumstances, you may file a provider appeal or claim action request with the provider dispute form.

Provider Appeal

If you are a participating provider and your claim was denied for lack of prior authorization, please submit an appeal via the provider dispute form. You have 120 days from the date of the claim remittance advice to submit an appeal. Make sure all the fields of the form are filled out, because if information is missing, it cannot be reviewed. Provider appeals will be reviewed within 45 business days from when they are received. All decisions are final, and you will be notified within five business days of the decision. If you are a non-participating provider, you do not have provider appeal rights.

Claims Action Request

If the claim denial is related to bundling, modifiers, global days or incorrect payment (see key terms below), please submit a claims action form (via the provider dispute form) within 120 days from the date of the claim remittance advice. Please ensure all the fields of the form are completed. If information is missing, it cannot be reviewed. After the request is reviewed, you will be faxed a determination within 45 business days.

Submit Provider Dispute Form

Key Terms

Bundling
Services billed were bundled into a package and should not be billed separately.

Claims Action Form
Used for claims denied for provider financial responsibility due to bundling, modifier or incorrect payment.

Global Days
Service was billed within the global period.

Incorrect Payment
Provider is requesting review of payment for issues such as endoscopic rules, modifier, bundling, global days, etc.

Modifier
Modifier is required for payment or modifier reduced payment.

Provider Dispute Form
Used for participating provider claims denied for provider financial responsibility when the authorization process was not followed due to extenuating circumstances.

View and Edit Claims

Claims Editing System in Provider Portal

The claims editing system is an easy and efficient tool intended to help providers look up claims reduced in payment due to claims editing or to see if a claim would apply edits. This portal is for coding edits only; not all of Network Health’s claim edits will display here. Also, it is for Network Health business only and cannot be used by or for another payer.

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. 

• New Enrollment
• Add/Delete/Change

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.