Prior Authorization & Medical Policies
Use these resources (organized by benefit plan type) to check prior authorization
requirements, make requests, and reference medical policies.
Code Lists (Standard list includes eviCore)*
Lookup Tool
Inpatient Admissions Quick Guide
PharmacyOnline Request – AZ Standard
eviCore Request*
Fax Request - Healthcare Services
Fax Request - Medications/DME
Gold Card ProgramPharmacy:
Call the number on the back of the ID card
Cover My Meds®
Surescripts®eviCore Guidelines
AZ Blue-Proprietary Policies
MCG Care Guidelines (Practice Management > Medical Policies > AZ Blue Plans-MCG Care Guidelines Search)
Chiropractic Guidelines (ASH)
Pharmacy Coverage Guidelines* To check if a member is delegated for eviCore, do an eligibility/benefits inquiry using the Health Benefit Plan Coverage service type.
Content restricted by user role or network status (or both).Our 2024 PCP Coordinated Care HMO (PCP-HMO) plan is the ACA StandardHealth with Health Choice Plan.
Please visit the Health Choice provider portal for:
Prior Authorization Requirements and Requests
Clinical GuidelinesUse the BlueCard router tools (log in) for prior authorization and medical policy information. Simply enter the member’s ID prefix to be routed to the correct AZ Blue Plan. Or call the number on the back of the member ID card.
Call 602-864-4102 or 1-800-345-7562
Pharmacy:
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 restricted by user role or network status (or both).Code Lists (Medicare Advantage tab)*
Inpatient Admissions Quick Guide
Part D FormularyHMO plans may have a different plan administrator (as indicated on the back of the member ID card):
OptumCare Arizona
Arizona Priority Care (AZPC)Fax Request
eviCore Request*
OptumCare Arizona
Arizona Priority Care (AZPC)Part 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
AZ Blue-Proprietary PoliciesMCG Care Guidelines (for anything not
covered by the above sources):
Call AZ Blue at 1-800-446-8331* 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 use our search tool:
CHS Group - TPA Information Finder
Content restricted by user role or network status (or both). These plans use the following utilization management administrators:
Prefixes K8Y and K8Z:
AmeriBen at 1-800-388-3193
For pharmacy, Navitus at navitus.com or 1-866-333-2757Prefix NBT:
American Health Group at 1-800-847-7605
For pharmacy, Navitus at navitus.com or 1-855-673-6504Prefix PTP
AmeriBen at 1-800-388-3193
For pharmacy, Magellan at magellanrx.com or 1-800-424-0472- 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.