Prior Auth Required

11625 - P.O. Box , Green Bay, WI -1625 Phone: 888-711-1444; 920-490-6900 _____/_____/______

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceP.O. Box , Green Bay, WI -1625 Phone: 888-711-1444; 920-490-6900 _____/_____/______
Procedure / Service Description

Arise Health Plan - Start Date of Service Arise Health Plan P.O. Box 11625, Green Bay, WI 54307-1625 Phone: 888-711-1444; 920-490-6900 _____/_____/______ PATIENT INFORMATION First Name: Last Name: Date of Birth: Subscriber Number:

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.