Who can make a Pre-Service Authorization?
Pre-Service Authorization is required for all non-participating providers and tertiary care specialists. An authorization request form must be submitted by the covered person’s Primary Care Practitioner (PCP) or a participating specialist. After the review, a written response by Arise Health Plan will be sent to the covered person and/or his/her PCP. It is the covered person’s responsibility to follow all authorization requirements. Other types of services require a Pre-Service Authorization to determine if the services are experimental, investigative, medically necessary, or excluded. This type of of authorization is a request for a determination of benefits by Arise Health Plan, PRIOR to services being rendered. This request can be initiated by calling Arise Health Plan toll-free at (888)-711-1444 or (920) 490-6900. Benefit determination is based upon the information available to us at the time the request is received.
