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.
Get familiar with a wide range of available programs and services for members and promote them to your patients, when appropriate.
Select “Opt-In for Electronic Communications” in your Prevea360 Health Plan portal account settings.
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.
2023 member plan and benefit highlights for provider awareness.
Issued: November 2022
Audience: All in-network providers
Effective date: 1/1/22
We are transitioning the claim appeals application in the Provider Portal.
Issued: August 2022
Audience: All in-network providers
Effective date: 8/24/22
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
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
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
Issued: August 2021
Audience: All providers
Effective date: N/A
Issued: August 2021
Audience: In-network prescribers
Effective date: 10/1/2021 & 1/1/22
Issued: July 2021
Audience: All in-network providers
Effective date: 7/22/21
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: 7/1/21
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: 1/1/21
See 2021 plan & benefits changes
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.
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