Prior Authorization & Medical Policies
Use the resources below (organized by benefit plan type) to check prior authorization
requirements, make requests, and reference medical policies. For a quick overview:
Prior Auth Requests - Quick Guide
Inpatient Notifications and Transfers - Quick Guide
Medical Policy Access - Quick Guide
Prior Auth Requirements How to Request Medical Policies Availity Essentials™ (auth feature)
EviCore Request*
Healthcare Services-Fax (AZ Standard)
Healthcare Services-Online (AZ Standard)
Medications/DME-Fax (AZ Standard)
Medications/DME-Online
Gold Card Program
Quick Transfer Program - Acute Care to SNFPharmacy:
Call the number on the back of the ID card
Cover My Meds®
Surescripts®EviCore Guidelines
AZ Blue-Proprietary Policies
MCG Care Guidelines (Availity Essentials Portal > AZ Blue Payer Space > Applications > Prior Auth & Medical Policies)
Chiropractic Guidelines (ASH)
Pharmacy Coverage Guidelines* To check if a member is delegated for EviCore, do an eligibility/benefits inquiry using service type 30 (Health Benefit Plan Coverage).
Content may only be accessed with a login.The ACA StandardHealth with Health Choice Plan (prefix IAZ) is supported by our Health Choice team.
Please visit the Health Choice provider portal for:
Prior Authorization Requirements and Requests
Clinical GuidelinesOur BlueCard router tools are easy to use. Simply enter the member ID prefix to be routed to the correct Blue Plan.
- For prior authorization preservice reviews, use the BlueCard Prior Authorization router tool (log in). Go to “Practice Management > Prior Authorization > BlueCard (Out-of-Area) Plans"
- For medical policies, use the BlueCard Medical Policy router tool.
Prior Auth Requirements How to Request Medical Policies Availity Essentials™ (auth feature)
Call 602-864-4102 or 1-800-345-7562Pharmacy:
Call the number on the back of the ID card
Cover My Meds®
Surescripts®
Call 1-877-727-3784FEP Medical Policies
FEP Utilization Management Guidelines
AZ Blue-Proprietary Policies
MCG Care Guidelines (Practice Management > Medical Policies > AZ Blue Plans-MCG Care Guidelines Search)
Prescription Drug Coverage
Content may only be accessed with a login.Prior Auth Requirements How to Request Medical Policies Availity Essentials™ (auth feature)
Code List (Medicare Advantage tab)
Prior Authorization Lookup
Inpatient Admissions Quick Guide
Part D FormularyPlans may have a different administrator for prior authorization (check the back of the member ID card):
Optum Health Network Arizona (OHNAZ)
Arizona Priority Care (AZPC)Availity Essentials™ (auth feature)
EviCore Request*
Fax Request
Optum Health Network Arizona (OHNAZ)
Arizona Priority Care (AZPC)
Quick Transfer Program - Acute Care to SNFPart D Drugs - Retail and Mail Order:
ePA covermymeds
ePA surescripts
Mail Order Fax 1-800-491-7997CMS National Coverage Determinations (NCD)
Local Coverage Determinations (LCD)
EviCore Guidelines
Medicare Advantage Ambulance ServicesMCG Care Guidelines (for anything not
covered by the above sources):
Call AZ Blue at 1-800-446-8331Part B Step Therapy Policies 2026
* All AZ Blue-administered Medicare Advantage plans are included in our EviCore Medicare Advantage program.- To access the CHS group’s utilization management information, call the number on the back of the ID card or access our CHS group and TPA contact list:
CHS Group/TPA Contact List
Content may only be accessed with a login. These plans are supported by a Blue Plan partner on behalf of AZ Blue.
- For prior authorization requirements and requests, use the Strategic Hub “My Insurance Manager” provider portal.
- For medical policies, visit the Strategic Hub Medical Policies page
- Groups with jointly administered plans use a third party for prior authorization and medical policies. Check the back of the ID card or reference our list of groups, prefixes, and UM contact information.
- Medicare Supplement plans (designed to cover payment gaps for those with traditional Medicare plans) align with CMS for coverage and medical necessity determinations. However, if a member’s Medicare Supplement plan covers benefits for foreign travel emergency services, AZ Blue will determine medical necessity.