Provider communications

Changes to health plan procedures, policies, and benefits

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.

Our Medica partnership

We communicate information about changes related to our partnership with Medica through our newsletters and other communications when needed. You'll find all of these linked from this web page.

Growing with a new partner - what to expect in 2023

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 (PDF)

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 (PDF)

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 (PDF)

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 (PDF)

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 (PDF)

New partnership with Medica

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

See provider announcement (PDF)

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 (PDF)

Enhanced Prevea360 website 

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

See website info (PDF)

Preventive Care and Screenings 

Issued: July 2021
Audience: All in-network providers  

See preventive care/screening info (PDF)

New member ID cards issued for some members 

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

See new ID cards (PDF)

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 (PDF)

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 (PDF)

Medical and drug policy updates

Starting November 1, 2023, policy notices are published in our monthly newsletters . 

Audience: all in-network providers

Notice dated: October 1, 2023 (PDF)

Notice dated: September 1, 2023 (PDF)

Notice dated: August 1, 2023 (PDF)

Notice dated: July 1, 2023 (PDF)

Notice dated: June 1, 2023 (PDF)

Notice dated: April 28, 2023 (PDF)

Notice dated: March 31, 2023 (PDF)

Notice dated: March 1, 2023 (PDF)

Notice dated: Feb. 1, 2023 (PDF)

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

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

Notice dated Nov. 1, 2022 (PDF): 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 (PDF)

Notice dated: Sept. 1, 2022 (PDF)

Notice dated: Aug. 1, 2022 (PDF)

Notice dated: July 1, 2022 (PDF)

Notice dated: June 1, 2022 (PDF)

Notice dated: April 29, 2022 (PDF)

Notice dated: April 1, 2022 (PDF)

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 (PDF)
Issued: February 2022
Effective date: 6/1/22

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