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.
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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.
We are transitioning the claim appeals application in the Provider Portal.
Issued: August 2022
Audience: All in-network providers
Effective date: 8/24/2022
Annual notification with member-centered plan and benefit topics for provider awareness for 2022.
Issued: November 2021
Audience: All in-network providers
Effective date: 1/1/2022
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: 1/1/2022
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: 12/1/2021
Issued: August 2021
Audience: All providers
Effective date: N/A
Issued: August 2021
Audience: In-network prescribers
Effective date: 10/1/2021 & 1/1/2022
Issued: July 2021
Audience: All in-network providers
Effective date: 7/22/2021
Issued: July 2021
Audience: All in-network providers
See preventive care/screening info
Issued: June 1, 2021
Effective date: 9/1/21
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: 7/1/2021
See knee & hip arthroplasty changes
Annual notification with member-centered plan and benefit topics for provider awareness for 2021.
Issued: October 2020
Audience: All in-network providers
Effective date: 1/1/2021
See 2021 plan & benefits changes
Cost share waiver for office visits through Dec. 31, 2020.
Issued: October 2020
Audience: All in-network providers
Effective date: 10/15/2020
Portal function allowing Provider Portal Site Administrators to apply updates to multiple user accounts all at once.
Issued: June 2020
Audience: Portal site administrators
Effective date: 6/29/2020
Introduction to new provider portal and its features.
Issued: May 2020
Audience: All in-network providers
Effective date: 6/1/2020
Audience: all in-network providers
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: 6/1/2022
Xeljanz (tofacitinib), Rinvoq (upadacitinib, Benlysta (belimumab, GAZYVA-obinutuzumab, SPINRAZA-nusinersen and retired policies
Issued: February 2022
Effective date: 5/1/2022
INFUGEM-gemcitabine, Parenteral Iron products and retired policy
Issued: December 2021
Effective date: 4/1/2022
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: 3/1/2022
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: 2/1/2022 & 4/1/2022
Medically Administered Oncology Products, Pegfilgrastim Products, PROLIA, XGEVA and retired policies
Issued: October 2021
Audience: All in-network providers
Effective date: 1/1/2022
ADAKVEO (crizanlizumab) and SIMPONI ARIA (golimumab)
Issued: July 2021
Audience: All in-network providers
Effective date: 11/1/2021
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: 10/1/2021
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: 8/1/2021
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: 7/1/2021
PROLIA/XGEVA, LUPRON-ELIGARD & INFLIXIMAB Infusions
Issued: March 2021
Effective date: 6/1/2021
Immune globulin
Issued: January 2021
Effective date: 5/1/2021
Trastuzumab products
Issued: December 2020
Effective date: 4/1/2021
Pegfilgrastim, Pertuzumaband, and Trastuzumab products
Issued: October 2020
Effective date: 2/1/2021
REBLOZYL, ENHERTU, KADCYLA and TRODELVY
Issued: September 2020
Effective date: 1/1/2021
SOLIRIS and ULTOMIRIS
Issued: May 2020
Effective date: 8/1/2020