Forms

FORM
AzAHP Practitioner Data Form
AzAHP Organizational/Facility Application
AzAHP Practitioner/Practice Change Form
Delegated Group Provider Roster
Non Delegated Group Provider Roster
2026 CPT and CDT Codes for Supplemental Benefits
2025 – 2026 Supplemental Benefits Comparison Chart
Provider’s Coding Toolkit
Medical Service and Behavioral Health Prior Authorization Form
Pharmacy Medication Prior Authorization Form
Waiver of Liability (WOL) Statement
Maternal Health Risk Assessment
Care Management Referral Form
Fraud, Waste and Abuse Referral Form
Prior Authorization and Continued Stay Review Form for Psychiatric Hospitals and Sub-Acute Facilities
BHIF, BHRF, TFC, and SUD BHRF Prior Authorization and Continued Stay Request Form
Medicare Prescription Drug Coverage and Your Rights