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 will communicate Information about changes related to our partnership with Medica through monthly policy notices, quarterly newsletters and other communications when needed. You'll find all of these linked from this web page.

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

Plan and benefit changes for 2023

2023 member plan and benefit highlights for provider awareness.
Issued: November 2022
Audience: All in-network providers
Effective date: 1/1/23

See 2023 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

Audience: All in-network providers

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