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Provider Resources

Policies and Forms

Network Health's policies are reviewed and updated annually. It is your responsibility to check this page often for new and/or revised policy changes.

Medicare Policies and Forms

We have collected information related to our Medicare processes, policies and procedures into one reference page called the Provider Medicare Manual.

Authorization Lists and Forms

Review authorization submission and response timelines, find listed services that require prior authorization for general medicine, pharmacy, genetic testing and experimental or investigational services. 

Medicare Plans
Commercial Plans

View Sample Member ID cards for help identifying patient plan types and benefits.


Medical Policies 

These medical policies provide guidance to the utilization management teams
at Network Health for considering and reviewing authorization requests for the
following treatment types:

Benign Skin and Subcutaneous Lesions
Breast Implant Removal and/or Replacement
Carotid Artery Stenting
Drug Metabolite and Alcohol Testing Frequency
Endobronchial Valves for the Treatment of Severe Emphysema
Home Phototherapy Units for the Treatment of Skin Conditions
LINX Reflux Management System
Mobile Cardiac Telemetry (MCT)
Orthognathic Surgery
Post Vitrectomy Support Devices 
Reduction Mammaplasty

Skin Substitutes - Collagen Dermal Matrix Materials
Specialized Manual Wheelchairs
Transgender and Gender Dysphoria / Gender Incongruence Services
Varicose Vein Treatments


Clinical Guidelines 

Network Health adopts and follows clinical practice guidelines to improve the quality of care for our members by assisting physicians and practitioners with a framework for specific illnesses. 

Read Clinical Practice Guidelines

Preventive Services Guide

In addition to an annual wellness visit, Network Health covers other preventive services at no cost for most of our members when they visit doctors within our provider network. Network Health follows the recommendations of the United States Preventive Services Task Force (USPSTF).

Commercial Preventive Services Guide

Appeals and Grievances Policies and Forms

For more information on the grievance process as well as member rights and responsibilities, please visit our legal page

Commercial Grievance Form
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


Credentialing Policies and Procedures

View policies and procedures related to credentialing, recredentialing and provider data maintenance for contracted providers.  


Network Health
1570 Midway Place
Menasha, WI 54952
Mon., Wed.-Fri.: 8 a.m. to 5 p.m.
Tuesday: 8 a.m. to 4 p.m.