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-InterQual (Practice Management > Medical Policies > BCBSAZ Plans-InterQual Search)
AZ Blue-Proprietary Policies
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).Standard Code List (includes eviCore)*
Lookup Tool
Inpatient Admissions Quick Guide
PharmacyPCP-HMO Prior Auth/Referral Tool (Practice Management > PCP Coordinated Care HMO Plans > Prior Auth Requests - Non-Std Option)
eviCore Request*
Gold Card ProgramPharmacy:
Call the number on the back of the ID card
Cover My Meds®
Surescripts®eviCore Guidelines
AZ Blue-InterQual (Practice Management > Medical Policies > BCBSAZ Plans-InterQual Search)
AZ Blue-Proprietary Policies
Chiropractic Guidelines (ASH)
Pharmacy Coverage Guidelines*All PCP Coordinated Care HMO plans are included in our eviCore program.
Content restricted by user role or network status (or both).Use 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
AZ Blue-InterQual (Practice Management > Medical Policies > BCBSAZ Plans-InterQual Search)
AZ Blue-Proprietary Policies
Prescription Drug CoverageContent 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:
Arizona Priority Care (AZPC)
P3 Health PartnerseviCore Guidelines
CMS National Coverage Determinations (NCD)
Local Coverage Determinations (LCD)MCG 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:
Call AmeriBen at 1-800-388-3193
For pharmacy, call Navitus at 1-866-333-2757
Prefix NBT:
Call American Health Group at 1-800-847-7605
For pharmacy, call Navitus at 1-855-673-6504