What is Prior Authorization
Prior authorizations are a pre-service medical necessity review. A prior authorization is the process where we review the requested service or drug to see if it is medically necessary and covered under ACA StandardHealth with Health Choice. Not all services and drugs need prior authorization. A prior authorization is not a guarantee of benefits or payment. The terms of the member’s plan control the available benefits.
Prior Authorization Guidelines
Requests for services that require prior authorization can be submitted on the ACA StandardHealth with Health Choice form by fax or requests can be phoned into the Authorizations department. All requests must include complete diagnosis and procedure codes, and the accompanying medical documentation (as needed).
In order to expedite prior authorization and provide quality services to our members, a contracted or preferred provider is recommended for all health care services for ACA StandardHealth with Health Choice members. Please note that all non-contracted providers must obtain prior authorization.
Prior Authorization Grid – effective 01/01/2024
Prescription Medication Formulary – effective 01/01/2024
Submitting a Prior Authorization Request
Through the Provider Portal
- ACA Standard Health with Health Choice PA FAX Line: 602-864-5308
- ACA StandardHealth with Health Choice Behavioral Health Out of Home Prior Auth Request FAX Line: 480-760-4732
Click here to access the PA Forms:
Checking PA Status:
You can view the status of Prior Auth requests on the Provider Portal.
If you have additional questions about Prior Auth requests please call 1-800-322-8670.
Dental Services Prior Authorization
Dental Prior Authorization Codes List
Requests for dental services that require prior authorization can be submitted on our secure provider portal (Add the link to the 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
Quick Links
To check the status of a prior authorization request or to view more information, sign in to the provider portal.
Prior Authorization Grid – effective 01/01/2024
Medical Services and Behavioral Health Prior Authorization Form