Forms

FORM
2025 CPT and CDT Codes for Supplemental Benefits
Medical Service and Behavioral Health Prior Authorization Form
Pharmacy Medication Prior Authorization Form
Medicare Prescription Drug Coverage and Your Rights
Waiver of Liability (WOL) Statement
Maternal Health Risk Assessment
Care Management Referral Form
Fraud, Waste and Abuse Referral Form
Provider’s Coding Toolkit
Request for Participation – AzAHP Practitioner Data Form
AzAHP Organizational/Facility Application
Practitioner Practice Change 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
Delegated Group Provider Roster
Non Delegated Group Provider Roster