WellFirst Health provider communications

Provider information

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.



About 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 benefits changes for 2023

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

See 2023 changes (PDF)

New claim appeals portal application

WellFirst Health is transitioning the Claim Appeals application in the Provider Portal.
Issued: August 2022
Audience: All in-network providers
Effective date: 8/24/22

View new claim appeals portal 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)

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)

Other information


Medical and drug policy updates

Audience: all in-network providers

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 (PDF)
Issued: February 2022
Effective date: 6/1/2022

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