Prior Auth Required

53008 - <Kip Sunshine> Rx BIN: <003858> Brookfield, WI -1725 Renewal Month: <Month>

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Service<Kip Sunshine> Rx BIN: <003858> Brookfield, WI -1725 Renewal Month: <Month>
Procedure / Service Description

DEDUCTIBLES ONLY - <Sissy Sunshine> Pharmacy Information: ATTN: Family Savings PlanGroup Name: STATE OF WISCONSIN P.O. Box 1725 Group Number: <00000000> <Kip Sunshine> Rx BIN: <003858> Brookfield, WI 53008-1725 Renewal Month: <Month> RxPCN: <SSN> Fax: 262-825-9690 networkhealth.com Effective Date: <MM/DD/YYYY>

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.