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Provider Resources

Claims Resources

Claims Submission and Reimbursement

It is Network Health’s goal to process all claims at initial submission. Before we can process a claim, it must be a “clean” or complete claim submission. If any of the necessary information is missing from the claim, we will be unable to process your claim in a timely fashion.

To facilitate the timely processing of your claims, please review Network Health’s Claim Submission Policy.

Ways to Submit a Claim

Providers are strongly encouraged to submit claims electronically for claims processing. For those that do not have the ability to submit electronically, Network Health has partnered with ConnectCenter, which offers participating providers the ability to submit claims electronically at no charge. Please contact Member Experience or your Provider Operations Manager to learn more.

Network Health Payer IDs

  • Medicare claims 77076
  • Commercial claims 39144

Network Health address

PO Box 568 Menasha, WI 54952

Medicare Benefits at a Glance

View the benefits for our Medicare Advantage plans from the current and previous plan year.

2024 Benefits at a Glance - Medicare Advantage Benefits for Providers
2023 Benefits at a Glance - Medicare Advantage Benefits for Providers

ECHO Health, Inc

Provider Payment Options and Electronic Remittance Advice (ERA)

Network Health partnered with ECHO Health, Inc to provide the following payment options for our providers.

  • Electronic Fund Transfer (EFT) – receive EFT from all payers.  A fee for this service may be required.
  • EFT payments for Network Health only - no fee is required. Click here to enroll.
  • Medical Payment Exchange (MPX) – the provider receives an email or fax notifying them they have a payment waiting.  If no action is taken within 3 business days, the payment is released to a paper check.
  • Virtual Credit Card (VCC) - including the explanation of payment (EOP). The step for processing payments is similar to how providers manually input patient payments today.

Please note: If the provider wishes to receive paper checks, they must opt out of VCC and MPX by visiting echovcards.com or calling 800-339-4718.  The ECHO EPC Draft Number located on your provider remittance advice is required to opt out.

The frequently asked questions document is available for questions related to EFT and ERA registration.

You may contact ECHO Health directly at 888-834-3511 for questions related to your electronic payments or ERAs.

Visit ECHO Health at www.providerpayments.com to view detailed explanations of payment (EOP).

Network Health Payor Identification Numbers

  • Commercial - 39144
  • Medicare - 77076

View Claim Status

Check status of claims by logging into the Provider Portal. Select the Claims tab (located on the navigation bar to the right), then select View Claims from the drop-down selection.

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. 

Claims Appeal/Dispute 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.

Per our provider dispute policy, all provider disputes and appeals must be submitted via our provider portal. 

Member Experience Team Phone Numbers

Medicare Commercial 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 60 days to file an appeal.

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

Please ensure that you review Network Health's Claims Submission Policy prior to submitting your dispute. You can find this policy as well as all payment policies here: https://networkhealth.com/provider-resources/policies-and-forms

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

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.

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