Provider Resources

Welcome Providers

At Network Health, our mission is to enhance the life, health and wellness of the people we serve. Our relationship with providers plays a vital role in that mission, so we make it a priority to provide you and your staff with tools to streamline the process of serving our members.

This online toolkit includes a collection of valuable resources.

Provider Portal Access

Registered providers have access to view patient eligibility, check status of claims, submit online authorizations and more. Registration is available for both participating and non-participating providers. Sign up now.

Authorization Information

Network Health uses online authorization systems to streamline communication and improve turnaround times for submissions. Learn more about iExchange, eviCore and Care Continuum. Find resources such as tutorials, authorization lists, FAQs and member ID card explanations.  

Claims Resources

Our goal is to process all claims at initial submission. We provide access to claims procedures and policies to help facilitate the timely processing of submissions. You will also find information about the claims dispute process, provider appeals and claims action requests.

Policies and Forms

Network Health reviews and updates commercial, Medicare and general medical policies regularly. We encourage you to visit this section often for policy changes. You will also find links to frequently used forms.

Pharmacy Information

Network Health manages prescription drug plan formularies for commercial, exchange and Medicare plans. We provide information and resources to help you navigate the subtle differences in tier structures, utilization management rules and other requirements or restrictions.

News and Announcements

Check out our monthly provider e-newsletter, The Pulse, to stay up-to-date on the latest news and trends. 

 

Become a Contracted Provider

If you’re looking for the biggest health plan in the nation, that’s not us. We are careful when selecting our provider partners—we look for those who are the best at what they do and bring value to our network. Read more to see if Network Health is the place for you. 

Credentialing and Provider Informatics

The credentialing process plays a vital role in providing safe, quality patient care to our members. Our credentialing department evaluates the qualifications of providers who wish to become affiliated with Network Health, conducts ongoing assessments of contracted providers and maintains the data for provider directories.

Quality Health Integration

Network Health collaborates with providers to ensure members receive the highest quality care. Review clinical practice guidelines, learn more about quality measures and rankings (NCQA, HEDIS, CAHPS) and find resources and tools to meet quality goals.

Wellness Programs

Learn more about Network Health’s programs for members, including Care Management, Condition Management and Member Wellness. Refer patients to take advantage of these programs for better health outcomes and overall wellness.

Provider Medicare Manual

Find all of our Medicare processes, policies and procedures in one reference manual. 


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.