Prior Authorization And Medical Policies

Prior Authorization & Medical Policies

Use these resources (organized by benefit plan type) to check prior authorization
requirements, make requests, and reference medical policies.

Prior Auth Requirements	How to Request	Medical Policies
Code Lists (Standard list includes eviCore)* Lookup Tool Inpatient Admissions Quick Guide Pharmacy	Online Request – AZ Standard eviCore Request* Fax Request - Healthcare Services Fax Request - Medications/DME Gold Card Program Pharmacy: 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).

Prior Auth Requirements	How to Request	Medical Policies
Standard Code List (includes eviCore)* Lookup Tool Inpatient Admissions Quick Guide Pharmacy	PCP-HMO Prior Auth/Referral Tool (Practice Management > PCP Coordinated Care HMO Plans > Prior Auth Requests - Non-Std Option) eviCore Request* Gold Card Program Pharmacy: 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.

Prior Auth Requirements	How to Request	Medical Policies
Code Lists (FEP tab) Inpatient Admissions Quick Guide FEP Prior Approval Drug List FEP Specialty Pharmacy Drug List	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 AZ Blue-InterQual (Practice Management > Medical Policies > BCBSAZ Plans-InterQual Search) AZ Blue-Proprietary Policies Prescription Drug Coverage

Content restricted by user role or network status (or both).

Prior Auth Requirements	How to Request	Medical Policies
Code Lists (Medicare Advantage tab)* Inpatient Admissions Quick Guide Part D Formulary HMO plans may have a different plan administrator: Arizona Priority Care (AZPC) P3 Health Partners	Fax Request eviCore Request* Arizona Priority Care (AZPC) P3 Health Partners Part D Drugs: Online Request Fax Request Mail Order Prescriptions	eviCore 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).

Prior Auth Requirements	PRIOR AUTHORIZATION REQUESTS and MEDICAL POLICIES
Summary List	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

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