Prior Authorization & Clinical Guidelines

Our goal is to work closely with you and your practice team to streamline and expedite prior authorization. Many of the items on our abbreviated prior authorization list ask for notification only. Our centralized prior authorization center is designed to streamline processes resulting in timely expedited approval of prior authorization requests. Prior Authorization Guidelines

Requests for services that require prior authorization can be submitted on the Prior Authorization form directly through the secure provider portal or via fax to the Authorizations department. All requests must include complete diagnosis and procedure codes, and the accompanying medical documentation (as needed).

In order to expedite prior authorization and provide quality services to our members, a contracted or preferred provider is recommended for all health care services for our members. Please note that all non-contracted providers must obtain authorization for any service. All out of state provider must have or be willing to obtain a valid and current AHCCCS ID number. AHCCCS-covered out of state care must be of an urgent or emergent nature.

Submitting a Prior Authorization

• Medical PA Phone: 1-800-656-8991
• Medical PA Fax Line: 1-877-424-5680
• Pharmacy PA Fax Line: 1-877-422-8130

Click here to access Prior Authorization Forms

EviCore

We are partnered with EviCore for radiology benefits management of select MR, CT, PET, ultrasound and cardiac imaging studies.

• EviCore Quick Reference Guide
• General Provider Orientation

To submit a new request for imaging services and select cardiac testing/procedures, contact EviCore by:

Phone:1-800-421-7592
Fax:1-800-540-2406
Email: ClientServices@Evicore.com
Provider Portal: https://www.evicore.com/pages/providerlogin.aspx