Provider communications

We release communications to in-network providers about changes to health plan procedures, policies, and benefits, as well as information about larger initiatives. This page lists some of our issued notifications for reference.


Member resources

Get familiar with a wide range of available programs and services for members and promote them to your patients, when appropriate.

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Onboarding guide

Designed to follow the onboarding process of a new in-network provider, and also a useful reference for all in-network providers, the onboarding guide highlights a specific area of business or functionality in each section. Plus, use the Quick Reference for quick access to a variety of resources.

Plan and benefits changes for 2023

2023 member plan and benefit highlights for provider awareness.
Issued: November 2022
Audience: All in-network providers
Effective date: 1/1/22

See 2023 changes

New claim appeals portal application

We are transitioning the claim appeals application in the Provider Portal. 
Issued: August 2022
Audience: All in-network providers
Effective date: 8/24/22

See new claims application

Plan and benefit changes for 2022

Annual notification with member-centered plan and benefit topics for provider awareness for 2022.
Issued: November 2021
Audience: All in-network providers
Effective date: 1/1/22

See 2022 changes


ACA and Medicare Advantage plans expansion

ACA Individual Plans and Prevea360 Medicare Advantage Plans are available in Chippewa and Eau Claire counties.
Issued: October 2021
Audience: In-network providers in Chippewa and Eau Claire counties
Effective date: 1/1/22

See expansion details


New drugs are not covered until reviewed and approved by P&T Committee

FDA approved drugs that are new to the market will not be covered until they are reviewed and approved by P&T Committee.
Issued: September 2021
Audience: All in-network providers
Effective date: 12/1/21

See P&T Committee change


New partnership with Medica

Issued: August 2021
Audience: All providers
Effective date: N/A

See provider announcement

See announcement Q&A


New policy for viscosupplement products 

Issued: August 2021
Audience: In-network prescribers
Effective date: 10/1/2021 & 1/1/22

See new vicosupplement policy


Enhanced Prevea360 website 

Issued: July 2021
Audience: All in-network providers ­
Effective date: 7/22/21

See website info


Preventive Care and Screenings 

Issued: July 2021
Audience: All in-network providers  

See preventive care/screening info


New member ID cards issued for some members 

Issued: June 1, 2021
Effective date: 9/1/21

See new ID cards

             


Total knee & total hip arthroplasty prior authorization changes

Changes to the prior authorization process for inpatient and outpatient total knee arthroplasty and total hip arthroplasty procedures.
Issued: April 2021
Audience: Orthopedists and orthopedic surgeons
Effective date: 7/1/21

See knee & hip arthroplasty changes              


Plan and benefit changes for 2021

Annual notification with member-centered plan and benefit topics for provider awareness for 2021.
Issued: October 2020
Audience: All in-network providers
Effective date: 1/1/21

See 2021 plan & benefits changes                                                                                  


Medical and drug policy updates

Audience: all in-network providers

Notice dated: Dec. 30, 2022: Features new medical policies for oncology genetic testing and transplantation.

Notice dated Dec. 1, 2022: Features rare diseases and system specialty specific new genetic testing medical policies.

Notice dated Nov. 1, 2022: Features prenatal new genetic testing medical policies, updated clinical guidelines for imaging and MSK, oncology program reminders and ACA medical record reviews. 

Notice dated: Sept. 30, 2022

Notice dated: Sept. 1, 2022

Notice dated: Aug. 1, 2022

Notice dated: July 1, 2022

Notice dated: June 1, 2022

Notice dated: April 29, 2022

Notice dated: April 1, 2022


Pharmacy material change notices

For pharmacy updates issued on and after April 1, 2022, see the medical and drug policy updates listed on this page.

Audience: all in-network providers

ALDURAZYME-laronidase, ARANESP-darbepoetin alpha, ELAPRASE-idursulfase, ELELYSO-taliglucerase alfa, Epoetin Alfa Products, NAGLAZYME-galsulfase, VIMIZIM-elosulfase, and retired policy
Issued: February 2022
Effective date: 6/1/22

Xeljanz (tofacitinib), Rinvoq (upadacitinib, Benlysta (belimumab, GAZYVA-obinutuzumab, SPINRAZA-nusinersen and retired policies
Issued: February 2022
Effective date: 5/1/22

INFUGEM-gemcitabine, Parenteral Iron products and retired policy
Issued: December 2021
Effective date: 4/1/22

CRYSVITA (burosumab)
Also includes changes to fax and phone numbers on Medical Benefit Drug Prior Authorization Forms and the new Pharmacy and Therapeutics Committee review process.
Issued: December 2021
Effective date: 3/1/22

Medicare Part B step therapy, ORENCIA (abatacept-IV) SIMPONI ARIA (golimumab), FLOLAN-epoprostenol-REMODULIN-treprostinil and new drug policies for Medicare Advantage
Issued: October 2021
Audience: All in-network providers
Effective date: 2/1/22 & 4/1/22

Medically Administered Oncology Products, Pegfilgrastim Products, PROLIA, XGEVA and retired policies
Issued: October 2021
Audience: All in-network providers
Effective date: 1/1/22

ADAKVEO (crizanlizumab) and SIMPONI ARIA (golimumab)
Issued: July 2021
Audience: All in-network providers
Effective date: 11/1/21

ALPHA 1- ANTITRYPSIN INHIBITOR, KRYSTEXXA (pegloticase), VISUDYNE (verteporfin), Antihemophilic Factor VIII Products, Antihemophilic Factor IX Products, Hyaluronic acid derivatives, Duchenne NMN, ENTYVIO (vedolizumab) and Antihemophilia Factors and Clotting Factors
Issued: July 2021
Effective date: 10/1/21

Medically administered oncology products, SPRAVATA (esketamine) and retired drug policies
Issued: June 2021
Effective date: 9/1/21

OCREVUS (ocrelizumab)
Issued: 
April 2021
Effective date: 8/1/21

BELEODAQ, BLINCYTO, ERBITUX, CEREZYME®, ELAPRASE®, EVRYSDI, LUMIZYME®, NAGLAZYME®, VIMIZIM®, & VPRIV®
Also includes changes to preventive drug list for commercial members.
Issued: April 2021
Effective date: 7/1/21

PROLIA/XGEVA, LUPRON-ELIGARD & INFLIXIMAB Infusions
Issued: March 2021
Effective date: 6/1/21

Immune globulin
Issued: January 2021
Effective date: 5/1/21