Network Health 2024 Medicare Advantage PPO plans are rated 5 out of 5 stars by Medicare. Learn more.

Provider Resources

Forms

Below you will find up-to-date forms for submission to Network Health or third-party partner organizations. Please check this page often as some forms are updated annually. 

Activity Level of Care Form (ALOC – SNF Facility)
Notice of Medicare Non-Coverage Form (Home Health Care)
Notice of Medicare Non-Coverage Form (Skilled Nursing Facility)
Recoupment Request Form
Authorization Request Form


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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