Prior Auth Required

53717 - John Q. Hammons Drive, Madison, WI , Telephone: (608) 251-4156, TTY: (608) 828-4815, Fax: (608) 257-3842, or

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceJohn Q. Hammons Drive, Madison, WI , Telephone: (608) 251-4156, TTY: (608) 828-4815, Fax: (608) 257-3842, or
Procedure / Service Description

If you believe that GHC-SCW has failed to provide these services or discriminated in another way on the basis of race, - If you believe that GHC-SCW has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with GHC-SCW’s Chief Compliance Officer, 1265 John Q. Hammons Drive, Madison, WI 53717, Telephone: (608) 251-4156, TTY: (608) 828-4815, Fax: (608) 257-3842, or Email: compliance@ghcscw.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, GHC-SCW’s Chief Compliance Officer is available to help you.

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.