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.





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 8/24/2022

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: 1/1/2022

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: 1/1/2022


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: 12/1/2021


New partnership with Medica 

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


New policy for viscosupplement products 

Issued: August 2021
Audience: In-network prescribers
Effective date: 10/1/2021 & 1/1/2022


Preventive care and screenings 

Issued: July 2021
Audience: All in-network providers  


Brand Adderall XR removed from formulary 

Issued: July 2021
Audience: All in-network providers ­
Effective date: 7/1/2021


New member ID cards for some members

Issued: May 2021 ­
Audience: All in-network providers ­
Effective date: 7/1/2021


Medicaid product expansion

Dean Health Plan BadgerCare Plus available to residents in Fond Du Lac and Green counties.
Issued: May 2021 ­
Audience: Fond Du Lac and Green providers ­
Effective date: 7/1/2021


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: 7/1/2021


Marshfield Medical Center-Beaver Dam and Marshfield Clinic sites no longer in-network

Announcement of provider network change detailing continuity of care and transitional information.
Issued: February 2021        
Audience: Providers in Dodge and adjacent counties
Effective date: 3/1/2021


Member cost-share waiver

Cost share waiver for office visits through Dec. 31, 2020.
Issued: October 2020        
Audience: All in-network providers                 
Effective date: 10/15/2020


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: 1/1/2021


Provider portal bulk edit function

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


New provider portal

Per Wisconsin Medicaid policy, providers must use HIPPS code with a corresponding revenue code on applicable SNF claims submitted to Dean Health Plan. 
Issued: March 2020            
Audience: All in-network providers                
Effective date: 3/8/2020

 



Medical and drug policy updates

Audience: All in-network providers

Notice dated: September 30, 2022

Notice dated: September 1, 2022

Notice dated: August 1, 2022

Notice dated: July 1, 2022

Notice dated: June 1, 2022

Notice dated: April 1, 2022

Notice dated: April 29, 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: 6/1/2022 

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
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, SPRAVATO (eskatamine) and retired drug policies.
Issued: June 2021
Effective date: 9/1/2021 

OCREVUS (ocrelizuab)
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