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 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)
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.