Dental Documents / Guides

For full benefit details, a complete list of covered dental codes, and specific excluded services, please refer to the following guidance:

• Dental Prior Authorization Code List
• 2025 Ste E Individual HMO ACA StndHlth w HC On Base Benefit Book
• 2025 Ste E Individual HMO ACA StndHlth w HC Off Base Benefit Book

Dental Prior Authorizations

Requests for dental services that require prior authorization can be submitted on our secure provider portal or by email using the dental prior authorization secured email: HCHDentalDeptHCA@azblue.com.

Providers can also mail their requests to:
ACA StandardHealth with Health Choice
Attn: Dental Prior Authorizations
8220 N. 23rd Ave.
Phoenix, AZ 85021