Please submit your completed forms to:

SISCO
800 Main St | PO Box 389
Dubuque, IA 52004-0389

Address change form - If you have currently moved or your address is incorrect with SISCO please fill out this form & send/fax to SISCO.

Authorization for Release form - If SISCO is requesting medical records in order to process claims, please fill out this form and mail back to SISCO or give directly to the provider's office that SISCO is requesting the documentation from.

EOB form - If you or any of your dependents have other Medical, Dental, Prescription, or Vision insurance through another carrier, please fill out this form and attach any Explanations of Benefits we have requested with this form.

Flex reimbursement form - This form needs to be attached to any flexible spending reimbursements submitted by the employee. Please fill out and attach this form to any flex reimbursements you are submitting.

Full-Time student form - If you have a dependent child age 19 and older, and is in school please have them fill out this form and give to their registrar office to have filled out. This form will have to be updated every semester the child is in school.

SISCO injury report form - If a patient received services due to an accident or injury please fill out this form and send in to SISCO. Any time there is a service involving any accident/injury this form will need to be filled out.

W9 form - If you are a new provider billing services to SISCO for reimbursement please fill out this form and send or fax to SISCO.