Blue Cross and Blue Shield of Arizona Prior Authorization

Blue Cross and Blue Shield of Arizona 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 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