Provider Resources

Health Insurance Exchange (HIX) Information

This section is designed to help you understand your patient's Prestige plan with Network Health. Members who have a Prestige NE or Prestige SE plan with Network Health will have member cards featuring either a NE or SE symbol. View the 2018 member ID card sample for more information. 

Please note that provider reimbursement and the prior authorization processes are the same for Prestige plan members as they are for all other commercial members. 

Prestige Provider Networks

View a list of the individual and family plan northeast (NE) and southeast (SE) Wisconsin providers in our tailored network with the links below.

Find a Doctor Prestige NE
Find a Doctor Prestige SE

IMPORTANT: Use these lists when referring patients to other providers. Please note providers must refer members in the NE and SE individual and family plan networks to providers in those networks. Services will not be covered if an individual or family plan member is referred outside the NE or SE network.

Premium Grace Period

The premium grace period only applies to individuals who are subsidized (receive an Advanced Premium Tax Credit) and are not paying their monthly premium. The premium grace period is 90 days.

You will receive a notification letter after day 31 of the grace period for a delinquent patient if you meet any of the following criteria. 

  • You are identified by Network Health as the individual’s primary care physician.
  • You have submitted medical claims on behalf of the individual.
  • You are identified by Network Health through the care management process.

During the first month of the grace period, the patient will continue to have coverage and claims will be paid by Network Health. During the second and third months of the grace period, claims will be placed in pending status. After the 90-day grace period, claims will be denied and become the patient’s obligation if the patient fails to pay the premium in full.

The individual’s record will note this grace period, if applicable. Providers can access this information via the provider portal or by calling Network Health’s Customer Service Department at 855-275-1400.

 


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.