Arizona Providers

Prior authorization requirements


Please verify benefit coverage prior to rendering services. Inpatient services and non-participating providers always require prior authorization.

Services billed with the following revenue codes ALWAYS require prior authorization:

Elective services provided by or arranged at nonparticipating facilities.

All services billed with the following revenue codes:

0023 Home health prospective payment system
0240–0249 All-inclusive ancillary psychiatric
0570–0572, 0579 Home health aide
0632 Pharmacy multiple sources
0901, 0905-0907, 0913, 0917 Behavioral health treatment services
0944-0945 Other therapeutic services
0961 Psychiatric professional fees
3101-3109 Adult day and foster care

Behavioral health

Fax all requests for services that require prior authorization to:

Inpatient:

1-877-434-7578

Outpatient:

1-800-505-1193

Pharmacy

Check the latest Formulary for the members’ service area on our Benefits and Pharmacy page.

Prior authorization code look-up

Please note:

  1. This tool is for outpatient services only.
  2. Inpatient services and non-participating providers always require prior authorization.
  3. This tool does not reflect benefits coverage,* nor does it include an exhaustive listing of all non-covered services (for example, experimental procedures, cosmetic surgery, etc.). Refer to your Provider Manual  for coverage/limitations.

* Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Please verify benefit coverage prior to rendering services.

To determine coverage of a particular service or procedure for a specific member:

  • Access eligibility and benefits information on the Availity Portal.
  • Use the Prior Authorization Lookup Tool accessed through Payer Spaces in Availity.
  • Call Provider Services at 1-866-805-4589 for Medicare Advantage.

Provider Tools and Resources

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We look forward to working with you to provide quality services to our members.