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.

See member resources guide for providers (PDF)

Growing with a new partner

Upcoming changes as we partner with Medica to align best practices and share technology.

See what to expect

Onboarding guide

Designed to follow the onboarding process of a new in-network provider—and also a useful reference for all in-network providers—the onboarding guide highlights a specific area of business or function in each section.

Plus, use the quick reference for quick access to a variety of resources.

See provider onboarding guide (PDF)

Our Medica partnership

Access information about Prevea360 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.

Prevea360 Health Plan Provider Quick Reference by Payer ID – identifies resources and processes with the addition of payer ID 41822.
Prevea360 Health Plan’s Just in Time for Providers - latest information on preparation and processes as we transition to business platforms under payer ID 41822.

View medical and drug policy updates

View pharmacy material change notices

Provider Authorization Submission Update

Upcoming changes & enhancements to the prior authorization experience with our health plan
Issued: August 14, 2024
Audience: All in-network providers

See August 14 provider communication (PDF)

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 (PDF)

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 benefits 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 (PDF)

Plan and benefits changes for 2023

2023 member plan and benefit highlights for provider awareness.
Issued: November 2022
Audience: All in-network providers
Effective date: 1/1/22

See 2023 changes (PDF)

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: 8/24/22

See new claims application (PDF)

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

See 2022 changes (PDF)

ACA and Medicare Advantage plans expansion

ACA Individual Plans and Prevea360 Medicare Advantage Plans are available in Chippewa and Eau Claire counties.
Issued: October 2021
Audience: In-network providers in Chippewa and Eau Claire counties
Effective date: 1/1/22

See expansion details (PDF)

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

See P&T Committee change (PDF)

New partnership with Medica

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

See provider announcement (PDF)

See announcement Q&A

New policy for viscosupplement products

Issued: August 2021
Audience: In-network prescribers
Effective date: 10/1/2021 & 1/1/22

See new vicosupplement policy (PDF)

Enhanced Prevea360 website

Issued: July 2021
Audience: All in-network providers
Effective date: 7/22/21

See website info (PDF)

Preventive Care and Screenings

Issued: July 2021
Audience: All in-network providers

See preventive care/screening info (PDF)

New member ID cards issued for some members

Issued: June 1, 2021
Effective date: 9/1/21

See new ID cards (PDF)

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

See knee & hip arthroplasty changes (PDF)

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: 1/1/21

See 2021 plan & benefits changes (PDF)

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 (PDF)

Notice dated: September 1, 2023 (PDF)

Notice dated: August 1, 2023 (PDF)

Notice dated: July 1, 2023 (PDF)

Notice dated: June 1, 2023 (PDF)

Notice dated: April 28, 2023 (PDF)

Notice dated: March 31, 2023 (PDF)

Notice dated: March 1, 2023 (PDF)

Notice dated: Feb. 1, 2023 (PDF)

Notice dated: Dec. 30, 2022 (PDF): Features new medical policies for oncology genetic testing and transplantation.

Notice dated Dec. 1, 2022 (PDF): Features rare diseases and system specialty specific new genetic testing medical policies.

Notice dated Nov. 1, 2022 (PDF): 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 (PDF)

Notice dated: Sept. 1, 2022 (PDF)

Notice dated: Aug. 1, 2022 (PDF)

Notice dated: July 1, 2022 (PDF)

Notice dated: June 1, 2022 (PDF)

Notice dated: April 29, 2022 (PDF)

Notice dated: April 1, 2022 (PDF)