Prior Auth Required

30653 - online at secure.wecareforwisconsin.com/documents/Providers/Provider Forms/Pre-Service Authorization Request Form/ -Arise-Prior-Auth-Referral.pdf

This procedure appears on the selected insurer prior authorization source.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / Serviceonline at secure.wecareforwisconsin.com/documents/Providers/Provider Forms/Pre-Service Authorization Request Form/ -Arise-Prior-Auth-Referral.pdf
Procedure / Service Description

authorization, or pre-certification. - Prior authorization requests may be submitted by providers via iExchange (preferred) or fax to 608-327-6300. The Prior Authorization forms may be found online at secure.wecareforwisconsin.com/documents/Providers/Provider Forms/Pre-Service Authorization Request Form/30653-Arise-Prior-Auth-Referral.pdf. For more information about iExchange, please go to wpshealth.com/shared/arise/iexchange/index.shtml.

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.