Arizona Complete Health Prior Authorization

Arizona Complete Health prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Prior authorization is required for some services, and out-of-network services generally require prior authorization except ER and family planning. Requests may be submitted via web portal, fax, or phone, and should include all necessary clinical information. The site states that emergency room and post-stabilization services never require prior authorization. Timing differs by line of business: standard requests are 7 calendar days for Medicaid and Medicare and 14 calendar days for Marketplace, with expedited/urgent requests within 72 hours. The site also notes 2026 timing changes, including possible 14-day extensions and future reductions in standard turnaround time for Medicare and Medicaid.
• Authorization is not a guarantee of payment.
• Member must be eligible at the time services are rendered and the service must be covered and medically necessary.
• The prior authorization page says the prior authorization list will be posted soon, so service-by-service requirements may need confirmation in the portal or related forms.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2

How to submit prior authorization requests

• secure provider portal

• fax

• phone

• Submission resource 1

• Submission resource 2

Information commonly required

• all necessary clinical information pertinent to the requested treatment/services
• provider signature certifying urgency for expedited requests

Turnaround notes and caveats

• Standard request: Medicaid and Medicare 7 calendar days; Marketplace 14 calendar days.
• Expedited (urgent) request: 72 hours.
• We will process most routine authorizations within five business days, but additional clinical review may take up to 14 calendar days.
• A possible extension of up to 14 calendar days may be requested by the member or provider, or by AzCH-CCP if additional information is needed and the delay is in the member’s best interest.
• Starting January 1, 2026, Medicare standard authorization requests decrease from 14 to 7 calendar days; beginning October 1, 2026, Medicaid standard authorization requests decrease from 14 to 7 calendar days.
• Authorization is not a guarantee of payment.
• Member must be eligible at the time services are rendered and the service must be covered and medically necessary.
• The prior authorization page says the prior authorization list will be posted soon, so service-by-service requirements may need confirmation in the portal or related forms.

Provider resources

• Provider Portal Login (official)
• Prior Authorization (official)
• Claims and Payment (official)
• Remittance Advice (official)
• Electronic Transactions (official)
• Medicaid Provider Claim Resolution Process (official)
• Arizona Complete Health Transition to Availity Essentials (official)

Sources