find a doctor Search our online provider directory
state health plan ETF’s Wisconsin group health insurance program
buy from the trust Insurance and other products
resource center FAQ’s, common links and forms
close
x
State Enrollment Plan
Required Clinical Information | Providers

Required Clinical Information

This list is not intended to be inclusive of all services that need to be authorized and is subject to change. 

Complete Preauthorization List
Service
Clinical Information Needed for Review
Back Procedures – Surgical Previous procedure reports; office/consultation notes from the referring and ordering provider (including history of past physical therapies and medications); recent MRI/CT scan report and any other related
Bone Growth Stimulator Current and previous office notes, operative report, current and previous imaging reports, and a description of the device
Hereditary Genetic Tests Office/consultation notes from the referring physician and/or genetic counselor, genetic counseling notes, lab reports and any other related information
Imaging Studies Office/consultation notes from the referring/ordering provider, imaging and lab reports, and any other related information. Please include any conservative therapy, including physical therapy, for spine imaging studies.
Infertility Testing Office/consultation notes from the referring/ordering provider, case summary, recent lab and ultrasound reports, and any other related information
MRA/MRV Office/consultation notes from the referring/ordering provider, a copy of the order for the MRA / MRV, and the ultrasound Doppler report (if applicable)
MRS Office/consultation notes from the referring/ordering provider, the recent MRI and MRS scan reports (if applicable) and any other related information
Neuropsychological Tests Office/consultation notes from the referring provider and/or psychologist, any previous neuropsychological test reports, and any other related information
PAP Device – Initial Office notes from the sleep medicine physicians; the sleep study report, including waveforms, graphs
PAP Device – Ongoing Office notes from the sleep medicine physicians; the sleep study report, including waveforms, graphs, and a download from the device documenting usage for the past three months
PET Scans Office notes, pathology report, previous imaging reports (including any previous PET scan reports) REMOVE:, and the most recent PET scan report
Sleep Study – Performed in a Facility (sleep studies performed in the home do not require authorization)
 Office notes from the referring provider, notes from the evaluation by the sleep medicine provider, medication history, and documentation indicating why the sleep study cannot be performed in the home
Sleep Study Titration Office notes from the referring provider, notes from the evaluation by the sleep medicine provider, medication history and the initial sleep study report
Varicose Veins Procedure report, notes from referring/ordering provider, ultrasound report and record of conservative therapy (medications/stockings)

If you have questions on what services require prior authorization, consult the Prior Authorization list located on www.WEATrust.com or contact Customer Service at 800-279-4000.

Customer Service

800-279-4000

Call us Monday through Friday - 7:30 a.m. to 5:00 p.m. CST

Email Us Today

For WEA Member Benefits (auto and home insurance & retirement services), call 800-279-4010

Customer Service