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To request a new or additional identification card on behalf of a member, please call the Arise Health Plan Billing and Enrollment Department, at (920) 617-6330.
Consent to disclose protected health information
Consentimiento para Divulgar Información Protegida
Prescription Drug Claim form
Prescription Mail/Fax order form
Payment option form
Primary Care Practitioner Designation Form
Facility Services Estimation of Out-of-Pocket Expenses Form
Professional Services Estimation of Out-of-Pocket Expenses Form