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

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. 

For dates of service on and after Jan. 1, 2024, we’re moving Individual and Family business (IFB)/ (Affordable Care Act) plans to the Availity Essentials Provider Portal under payer ID 41822. The authorization submission functionality in this portal is not yet available. To ensure that providers and their support teams can request prior authorizations while this function is being activated, follow the interim steps for one of the following submission options for dates of service on and after Jan. 1, 2024:

Option 1: Submit an electronic prior authorization form from Dean Health Plan provider portal:

  1. Sign in to your Dean Health Plan Provider Portal account, select the Authorization Submission Payer ID 41822 tile from Provider Portal homepage.
  2. Click “Inpatient and Outpatient Services” at the top of the page.
  3. 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.
  4. Submit the supporting documentation via one of the following ways:
    • Fax: 1-608-252-0830; or
    • Email: 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:

  1. 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.
  2. Complete all fields on the form. Note: Forms have been updated with added fields for information that will help facilitate authorization reviews.
  3. Submit the form and supporting documentation via:
  4. 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.
  5. 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.
  6. If necessary, fax or email authorization updates and cancellations using one of the methods listed in step 3.
See Dean Health Plan’s Just in Time for Providers (PDF) on how to obtain authorization status and determinations, and make updates to or cancel authorization requests.

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.
See these communications to learn more about our partnership with Medica:

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

See 2024 changes

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

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

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

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 & 1/1/22

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: 7/1/21

New member ID cards for some members

Issued: May 2021 ­
Audience: All in-network providers ­
Effective date: 7/1/21

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: 7/1/21

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

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

Notice dated: September 1, 2023

Notice dated: August 1, 2023

Notice dated: July 1, 2023

Notice dated: June 1, 2023

Notice dated: April 28, 2023

Notice dated: March 31, 2023

Notice dated: March 1, 2023

Notice dated: Feb. 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. 

Notice dated: Sept. 30, 2022

Notice dated: Sept. 1, 2022

Notice dated: Aug. 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: 6/1/22 

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