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.
Member resources
Get familiar with a wide range of available programs and services for members and promote them to your patients, when appropriate.
Growing with a new partner
Upcoming changes as we partner with Medica to align best practices and share technology.
Onboarding guide
Updated! For onboarding and ongoing reference, your all-in-one guide to resources and processes for all plan types under payer ID 39113.
Our Medica partnership
Access information about Dean Health Plan’s partnership with Medica, an independent, nonprofit health plan headquartered in Minnetonka, Minnesota, and how both health plans are using the partnership to strengthen their abilities to provide high quality support for providers and members.
- Dean Health Plan Provider Quick Reference by Payer ID – Identifies resources and processes with the addition of payer ID 41822.
- Dean Health Plan’s Just in Time for Providers – Latest information on preparation and processes as we transition to business platforms under payer ID 41822.
Option 1: Submit an electronic prior authorization form from Dean Health Plan provider portal:
- Sign in to your Dean Health Plan Provider Portal account, select the Authorization Submission Payer ID 41822 tile from Provider Portal homepage.
- Click “Inpatient and Outpatient Services” at the top of the page.
- Complete all fields on the form and click Submit. A message confirming receipt is sent. Note: The form must be completed and submitted within a single session as it cannot be saved and returned to for a future submission.
- Submit the supporting documentation via one of the following ways:
- Fax: 1-608-252-0830; or
- Email: ifbhealthmanagement@medica.com. For emailed supporting documentation, an acknowledgement is sent to the submitter’s email address.
Option 2: Fax or email prior authorization form from our website:
- Go to the Medical Management page and select the appropriate form under the “Prior Authorization Forms” section. Note: The new “General” form is for Outpatient and Inpatient requests.
- Complete all fields on the form. Note: Forms have been updated with added fields for information that will help facilitate authorization reviews.
- Submit the form and supporting documentation via:
- Fax: 1-608-252-0830; or
- Email: ifbhealthmanagement@medica.com. For emailed requests, an acknowledgement is sent to the submitter’s email address.
- To inquire about an authorization status, call customer care at 1-800-458-5512 once the processing timeframe has elapsed. All authorizations are processed in adherence to state and other regulatory turnaround times which can vary based on the authorization type and/or state in which the service will be provided. Please refer to the Dean Health Plan Provider Manual for determination and notification timeframes applicable to your authorization request before calling customer care.
- Receive authorization determinations (approved/denied) via fax, regardless of submission method, to the fax number that was entered on the authorization form. (Please monitor the return fax number for the determination.) All authorization determinations are mailed to the member, regardless of submission method.
- If necessary, fax or email authorization updates and cancellations using one of the methods listed in step 3.
Remember, Availity Essentials will only be for IFB business initially. You must retain your accounts in the Dean Health Plan Provider Portal for all other products under payer ID 39113.
- February 2024 Provider News – Learn why payer ID is so important.
- January 12, 2024 Provider Information – Are you using the correct resources for your patients?
- January 2024 Provider News – Processes and resources for new payer ID 41822.
- December 2023 Provider News – Preparing to move to new, long-term business platforms for IFB plans, including webinars featuring the new provider portal.
- November 2023 Provider News – Learn more about Availity Essentials provider portal applications and InstaMed payment services for 2024 IFB plans.
- Fall 2023 Provider News cover story – Announcing Availity as our new electronic data interchange (EDI) clearinghouse and provider portal vendor! Plus, new member ID cards and customer care phone numbers and technology.
- Summer 2023 Provider News cover story – Changes coming for claims processing and resources: What you need to know.
- Spring 2023 Provider News cover story – Pursuing innovations with a new partner.
- Growing with a New Partner – What to Expect in 2023 – Find out what’s ahead as we partner with Medica to align best practices and share technology, including a new, shared claims processing platform.
- Medica Q&A – Who is Medica, what's changing and how to stay informed this year.
Change Healthcare cybersecurity incident update
Our planned mitigation to the security incident.
Issued: March 26, 2024
Audience: All in-network providers
See March 26 provider communication (PDF)
Updated FAQ for providers
Services through Change Healthcare with any payer are not operating at this time.
Issued: March 8, 2024
Audience: All in-network providers
See March 8 provider communication (PDF)
Plan and benefit changes for 2024
2024 member plan and benefit highlights for provider awareness.
Issued: December 2023
Audience: All in-network providers
Effective date: 1/1/24
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: Changed to 8/24/22
View the new claim appeals portal application
Billing & reimbursement change for certain skilled nursing facility claims
Per Wisconsin Medicaid policy, providers must use HIPPS code with a corresponding revenue code on applicable SNF claims submitted to Dean Health Plan.
Issued: May 2022
Audience: SNF providers serving DeanCare Gold or Dean Select members.
Effective date: 1/1/22
Medical and drug policy updates
Starting November 1, 2023, policy notices are published in our monthly newsletters.
Audience: All in-network providers
Notice dated: September 1, 2023
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.
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