Provider Resources

Provider Medicare Manual

To help serve you better, we have collected information related to our Medicare processes, policies and procedures into one reference page.

If you have any questions about the information provided, please call our Medicare customer service department at 800-378-5234, Monday through Friday, 8 a.m. to 8 p.m. (TTY 800-947-3529).

Authorization Information

2019 Medicare PPO Prior Authorization List
2019 Medicare HMO Prior Authorization List
Authorization Request Timelines Guideline
iExchange and eviCore Healthcare Authorization Requests
Services Requiring Authorization

2018 Medicare Prior Authorization List

For the most up-to-date Experimental or Investigational Authorization List for Medicare members, please contact us at 800-378-5234, 
Monday through Friday from 8 a.m. to 8 p.m.

Medicare Authorization Request Form
Addendum Form for Medicare Authorization Request

Care Management Staff Accessibility to Members and Practitioners
Clinical Criteria for Utilization Decisions
Incentives for Utilization Decisions
Notice of Medicare Non-Coverage Form (Home Health Care)
Notice of Medicare Non-Coverage Form (Skilled Nursing Facility)

Grievance and Appeals Resolution Policy and Procedure for Medicare Advantage Plans Part D
Grievance and Appeals Resolution Policy and Procedure for Medicare Advantage Plans Part C

Claims Resources

Medicare and Commercial Claims Resources
Medicare Provider Payment Dispute and Appeal Rights Process, and Waiver of Liability Statement
Investigation Timeline for Medical Record Request and Review policy
Recoupment Request Form
Medicare Fraud, Waste and Abuse Program Plan

Provider Line for Claims Issues

This line is designed to specifically help Medicare providers with complex claims issues.
855-580-9935 or 920-720-1460

Credentialing 

Credentialing Process
Recredentialing Process
Medicare Opt Out
Practitioners Communication, Advice to Patients

General Policies

Business Information Protection
Diverse Population-Cultural and Linguistic Needs
No Member Discrimination in Delivery of Health Care
Privacy and Confidentiality of Member Information and Records
Prohibition of Health Screening Prior to Enrollment
Medicare Required Disclosure of Information to Beneficiaries

Medicare Plan Materials

View the plan documents below to learn more about Medicare member benefits. 

2019 Plan Materials
2019 Benefits at a Glance - Medicare Advantage Benefits for Providers

2018 Plan Materials
2018 Benefits at a Glance - Medicare Advantage Benefits for Providers

Pharmacy Information

Visit the Pharmacy Information page in the provider resources section. 

Safe Use of Opioid Pain Medication
The Centers for Medicare and Medicaid Services (CMS) has published guidance to help prescribers and pharmacists dispense opioid medications according to new Medicare drug policies. 

2019 Medicare Part D Opioid Policies: Information for Pharmacies
2019 Medicare Part D Opioid Policies: Information for Prescribers

Training

Network Cares (PPO SNP) Medicare Model of Care Training

 


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.