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.





Growing with a new partner - What to expect in 2023

Upcoming changes as we partner with Medica to align best practices and share technology.
Issued: January 2023
Audience: All in-network providers

What to expect in 2023

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


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: 3/1/21

 



Medical and drug policy updates

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. 

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 

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
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, SPRAVATO (eskatamine) 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