Blue Cross and Blue Shield of Arizona Prior Authorization

Blue Cross and Blue Shield of Arizona publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.

At a glance

• Prior authorization is plan-specific. For most AZ Blue plans, requests are submitted through AZ Blue’s online standardized forms or fax forms; EviCore is used for most commercial plans and all AZ Blue-administered Medicare Advantage plans. Exceptions include ACA StandardHealth with Health Choice, BlueCard out-of-area members, CHS group plans, co-administered plans, FEP, and Medicare Advantage members with specific routing/fax rules. AZ Blue states that some requests require medical records and that authorization is not a guarantee of payment.
• Prior authorization requirements and submission routes vary by plan type.
• AZ Blue says prior authorization is not a guarantee of payment.
• For some products, claim review may still occur even when authorization is not required.
• The lookup tool and code lists may lag new/revised codes; AZ Blue reserves the right to require authorization for newly released or updated items.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3
• Verification resource 4

How to submit prior authorization requests

• AZ Blue standardized online request tool

• AZ Blue standardized fax forms

• EviCore online provider tool

• BlueCard pre-service router tool

• Member-ID-card phone number / plan-specific phone line

• Urgent email or phone for clinical support

• Submission resource 1

• Submission resource 2

• Submission resource 3

Information commonly required

• Member ID
• Date of service or procedure date
• Procedure keyword or CPT code (no brand names)
• Plan type / member ID prefix when applicable
• Medical records for authorization decisions are typically required
• For urgent issues, reason for urgency / imminent treatment need

Turnaround notes and caveats

• Unscheduled admissions require notification within 48 hours for most AZ Blue plans.
• Medicare Advantage unscheduled admissions require notification within 24 hours.
• Urgent assistance is available 24/7 via UtilMgmt@azblue.com or 602-864-4320.
• Some large groups have customized extended hours and card-specific contact information.
• Prior authorization requirements and submission routes vary by plan type.
• AZ Blue says prior authorization is not a guarantee of payment.
• For some products, claim review may still occur even when authorization is not required.
• The lookup tool and code lists may lag new/revised codes; AZ Blue reserves the right to require authorization for newly released or updated items.

Provider resources

• Provider Resources hub (official)
• Provider Portal (general AZ Blue) (official)
• Electronic Options (official)
• Eligibility & Benefits (official)
• Prior Authorization Lookup (official)
• Provider Appeals and Grievances (official)
• Medicaid/Health Choice Claims (official)
• Health Choice Pathway Claims (official)
• Prior Authorization Requests – Quick Guide (PDF) (official)

Sources