Prior Authorization & Medical Policies

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Prior Authorization and 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) Code List - includes EviCore* Prior Authorization Lookup Inpatient Admissions Quick Guide Pharmacy	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 SNF Pharmacy: 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 Health Choice Network Plans (prefix IAZ) is supported by our Health Choice team.

Please visit the Health Choice provider portal for:
Prior Authorization Requirements and Requests
Clinical Guidelines

For prior authorization preservice reviews, use the Availity BlueCard Prior Authorization Request. process. When you check to see if authorization is required, you will be routed to the member’s Blue Plan for that information and request options.
For medical policies, use the BlueCard Medical Policy router tool.

Prior Auth Requirements	How to Request	Medical Policies
Availity Essentials™ (auth feature) Code Lists - FEP tab* Prior Authorization Lookup Inpatient Admissions Quick Guide FEP Prior Approval Drug List FEP Specialty Pharmacy Drug List	Availity Essentials™ (auth feature) 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 1-877-727-3784	FEP 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 Formulary Plans 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 SNF Part D Drugs - Retail and Mail Order: ePA covermymeds ePA surescripts Mail Order Fax 1-800-491-7997	CMS National Coverage Determinations (NCD) Local Coverage Determinations (LCD) EviCore Guidelines Medicare Advantage Ambulance Services Bioengineered Skin and Soft Tissue Substitutes MCG Care Guidelines (for anything not covered by the above sources): Call AZ Blue at 1-800-446-8331 Part B Step Therapy Policies 2026, 2027

* 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.

You can review our 2025 MA Prior Authorization metrics report here.

You can review our 2025 ACA Prior Authorization metrics report here.

Can’t find what you’re looking for? We’re here to help.

1-844-995-2583

Prior Authorization & Medical Policies

AZ Blue Plans – Applies to most AZ Blue members

ACA Health Choice Network Plans – Prefix IAZ

BlueCard (Out-of-Area) Plans – From other Blue Cross Blue Shield companies

Federal Employee Program (FEP) Plans – Prefix R

Medicare Advantage Plans – Prefix M2K

Corporate Health Services (CHS) Group Plans – Managed by third-party administrators (TPAs)

Strategic Hub Plans – Prefixes AOZ, AZI, AZK, and IVR

AZ Blue & TPA Jointly Administered Plans – Various prefixes (UM is administered by a third party)

Medicare Supplement Plans – Prefix XBS

Prior Authorization Reporting