Before your appointment: While we strive to provide accurate information about health care providers in our network, we recommend you call ahead to confirm their network status, address, office hours, and that they are accepting new patients.
The First Health Network is a large national network of directly held contracts with more than 6,000 hospitals, more than 130,000 ancillary facilities, and more than 1 million health care professional service locations in the United States, including Puerto Rico. Your plan includes the First Health Network as a wrap network for employees whose children attend school out of state and employees and their families that travel outside Wisconsin. Employees living out of state can also access the First Health Network for in-network care.
Disclaimer: All Mayo locations in Wisconsin and throughout the country are out of network; e.g., Mayo Clinic Health System, Mayo Clinic Rochester, Mayo Clinic Hospital - Saint Mary Campus, Mayo Clinic Hospital - Methodist Campus, Mayo Clinic Phoenix/Scottsdale, etc.
All Cancer Treatment Centers of America (CTCA)/Midwest Regional Medical Center (MRMC) locations and the physicians billing at these locations through Patient First, SC or CTCA Prof Corp are considered to be out of network.
You will incur higher out of pocket costs if you choose to receive care at any of these locations.
Non-Network Specialists and Tertiary Care require a pre-service authorization. The authorization must be approved by WPS Health Plan prior to services being rendered. Please contact Customer Service at 920-490-6900 or toll free at 800-711-1444 for further information.
Local providers and hospitals may refer patients to a tertiary hospital for major operations, consultations with subspecialists, and when sophisticated intensive care services are required. Referrals to tertiary care services not in your network require prior authorization.
Medical College of Wisconsin providers are treated as in-network for Pediatric Specialists only. Medical College providers treating adult patients will require prior authorization in order for services to be considered.
Facility accreditations and other demographic information are verified by the Credentialing Department during the initial credentialing process and again every three years. Please note that changes to the accreditation status of a facility made by the accrediting body within the three-year cycle and/or changes in name or location due to acquisitions, relocations, etc. occurring within the three-year cycle may not be reflected on this site.
Health care professionals are participating providers only at the locations specified.
Specialty, hospital affiliations, medical group affiliations, and languages spoken are verified by the Credentialing Department through the credentialing process every three years.
Board Certifications Board Certification is the process by which a provider is tested and approved to practice in a specialty field. are verified by the Credentialing Department through the credentialing process every three years. If a certification expires, it is reverified upon the expiration date.
To check Provider Residency, Medical School attended, and Board Certification Status for an MD/DO, the follow methods are available for public use:
Practitioner name, gender, and office location are obtained on the credentialing application and validated every three years as part of the recredentialing process.
WPS does not use quality measures, customer experience measures, or cost-related measures to select practitioners and hospitals.