Providers

At Network, we are committed to building and sustaining long-term relationships with the providers who serve our mutual communities. This is more than a promise. It is a commitment to the level of service, coverage and care that you, as a professional under oath, make to every patient, every day. That same level of service is also what you can expect from us, when our members are in your care.

To help serve you better, we have included information online and at your fingertips, which you will find valuable in continuing or beginning a successful partnership with Network Health Plans.

Network Platinum Medicare Advantage Provider Manual (pdf)

  1. GENERAL INFORMATION
    1. Product History
    2. Medicare Advantage Plans
    3. Disclosure of Quality and Performance Indicators to CMS 129
    4. Consideration of Linguistic and Cultural Needs of Members
    5. Privacy and Confidentiality of Member Information and Records
    6. Business Inforrmation Protection
    7. Fraud Waste and Abuse
    8. Prohibition of Health Screening Prior to Enrollment
    9. NHP/NHIC - Access - Practioner Plan Standards
    10. Medical Records Review Process
    11. Medicare Required Disclosure of Information to Beneficiaries
    12. Termination of Provider Services
    13. Grievance Resolution Policy and Procedure for Medicare Advantage Plans
    14. Network Health Plan/Network Health Insurance Corporation's Grievance Process
    15. Medicare Advantage Plans Financial Affairs and Beneficiary Protections
  2. CARE MANAGEMENT
    1. Services Requiring Authorization for Medicare Advantage PPO
    2. NHIC Medicare Advantage Specialty Care Access
    3. Clinical Criteria for Utillization Decisions Provider Authorization Request Process
    4. Medical Policy Development
    5. Policy on Incentives for Utilization Decisions
    6. CM Staff Accessibility to Members and Practioners
    7. Notice of Non Coverage
    8. Notice of Discharge and Medicare of Provder Services
    9. Termination of Provider Services
    10. Notice of Medicare Non-Coverage Forms
    11. Network Health Plan Outpatient Treatment Report for Behavioral Form
    12. Network Health Plan Outpatient Treatment Report for AODA services- Initial Form
    13. Network Health Plan Outpatient Treatment Report for AODA servies - Concurrent Form
  3. CLAIMS
    1. CMS - 1500 Professional Claim Information
    2. UB-04 Uniform Billing Claim Implementation
    3. Claims Mailing
  • (We have included helpful tools to assist you in locating content within the PDF. When the PDF opens, simply click on the “Bookmarks” tab – it is the top tab at the left of the panel that displays the PDF content. Then find and click on your topic of interest within the “Bookmarks” panel and the link will take you to the specific pertinent page(s) within the PDF. Alternatively, you can use the “Search” functionality. Just click on the binocular icon in the horizontal toolbar located above the panel that displays the PDF content. That will open a new window that will allow you to enter a search term – then enter your term or phrase and click the “search” button. Your results will appear in a new window below the “search” button.)

Required Provider Fraud, Waste and Abuse Training Program

Everyone has the right/responsibility to report possible Fraud, Waste and Abuse issues. You may report anonymously and retaliation is prohibited when you report a concern in good faith. Report issues to your organization’s Compliance Office, or the Compliance Officer of the applicable Plan Sponsor with whom you participate.

To report Fraud, Waste and Abuse issues for the Network Platinum Medicare Advantage Plans, please access the link below or contact the Network Health Insurance Corporation Medicare Compliance Administrator at 920-725-1225.To report Fraud, Waste and Abuse issues for the Network Platinum Medicare Advantage Plans, please access the link below or contact the Network Health Insurance Corporation Medicare Compliance Administrator at 920-725-1225.

Reporting a Fraud, Waste or Abuse Incident

NetworkCares Special Needs Plan Provider Training The NetworkCares Special Needs Plan Provider Training program is designed to help educate Providers on coordinating Medicare and Medicaid benefits for members of NetworkCares, a Medicare Advantage Special Needs Plan.

Check Member Eligibility Or Review Your Claims

Medicare Provider Payment Dispute and Appeal Rights Process

For more information from the State of Wisconsin on Medicaid, please visit the Wisconsin Department of Health Services’.