Medicare Out of Network Provider FAQs

Thank you for taking care of our Medicare Advantage members. We created this FAQ as a quick reference to make doing business with Network Health as easy as possible.

Claims information

Claims can be submitted to Network Health in the following ways.

1. Electronically by utilizing your clearinghouse and submitting claims under our Medicare Payer ID 77076

2. Via a paper claim, mailed to PO Box 568 Menasha, WI 54952

Network Health pays claims within 30 days. If you have not received payments after 30 days, please contact our Member Experience team at 855-580-9935

You have 365 days to submit a claim to Network Health. After 365 days, the claim will be denied as untimely and you cannot balance bill the member.

Member eligibility and benefit validation

You can verify member eligibility and validate benefits in the following ways.

1. Use real-time eligibility via your clearinghouse. You can use this functionality to check eligibilty for our members.

2. You can contact our Network Health Member Experience team at 855-580-9935

3. You can register for our Provider Portal (portal registration may take up to 10 business days).

Prior authorization

Prior authorization is not required for providers that are not in our network.

Network Health Medicare Advantage products

All of our Network Health Medicare Advantage products are PPO products, which means members can seek care in and out of network at the same cost share. Network Health will reimburse providers the same way as Original Medicare.

Network Health sample ID card

2025 Benefits at a Glance - Medicare Advantage Benefits for Providers

Medicare Advantage PPO Individual products

These are products purchased by the individual which are eligibile for Medicare Part A and Part B. The ID cards will list the product names as any of the following.

• Network Health Anywhere

• Network Health Armor

• Network Health Bravo

• Network Health Choice

• Network Health Go

• Network Health PlusRX

• Network Health PremiumRX

• Network Health Select

• Network Health Zero

Medicare Advantage D-SNP PPO Individual product

This product is purchased by the individual when they are eligible for Medicare Part A and Part B, and also have Medicaid. Members are considered dual-eligible when they have a Network Health Medicare Advantage product as primary and Medicaid as secondary. These individuals cannot be balance billed. The member's ID card will show the plan as Network Health Cares.

Medicare Advantage Medical Savings Account product

This product is purchased by an individual who is eligible for Medicare Part A and Part B. This is a high-deductible medical savings plan. All expenses are applied to the deductible. Once the deductible is satisfied, there is no cost share to the member. The member's ID card will show the plan as Network Health Prime.

Group Medicare Advantage product

Better known as EGWP, these are products purchased through the individual's employer. These individuals are eligible for Medicare Part A and Part B. The member's ID card will show the name of group as Cornerstone, Foundation, Core, Ultimate, etc. Please see important information here regarding this product.

Network Health Provider Portal

If you would like to register for our Network Health Provider Portal, click here.

Once you are registered, a PIN will be mailed to your address.

To see a video on how to navigate the Network Health Provider Portal once your account has been created, click here. 

Become a Network Health provider

If you would like to become a Network Health provider, please click here to fill out a form and request participation in our provider network.