Prior Authorization & Medical Policies
Use the resources below (organized by benefit plan type) to check prior authorization
requirements, make requests, and reference medical policies. For a quick overview:
Prior Auth Requests - Quick Guide
Inpatient Notifications and Transfers - Quick Guide
Medical Policy Access - Quick Guide
Code List - includes EviCore*
Lookup Tool
Inpatient Admissions Quick Guide
PharmacyOnline Request – AZ Standard
EviCore Request*
Fax Request - Healthcare Services
Fax Request - Medications/DME
Gold Card Program
Quick Transfer Program - Acute Care to SNFPharmacy:
Call the number on the back of the ID card
Cover My Meds®
Surescripts®EviCore Guidelines
AZ Blue-Proprietary Policies
MCG Care Guidelines (Practice Management > Medical Policies > AZ Blue Plans-MCG Care Guidelines Search)
Chiropractic Guidelines (ASH)
Pharmacy Coverage Guidelines* To check if a member is delegated for eviCore, do an eligibility/benefits inquiry using the Health Benefit Plan Coverage service type.
Content restricted by user role or network status (or both).The ACA StandardHealth with Health Choice Plan (prefix IAZ) is supported by our Health Choice team.
Please visit the Health Choice provider portal for:
Prior Authorization Requirements and Requests
Clinical GuidelinesUse the BlueCard router tools (log in) for prior authorization and medical policy information. Go to “Practice Management > Prior Authorization > BlueCard (Out-of-Area) Plans” and enter the member’s ID prefix to be routed to the correct Blue Plan. Or call the number on the back of the member ID card.
Call 602-864-4102 or 1-800-345-7562
Pharmacy:
Call the number on the back of the ID card
Cover My Meds®
Surescripts®
Call 1-877-727-3784FEP Medical Policies
FEP Utilization Management Guidelines
AZ Blue-Proprietary Policies
MCG Care Guidelines (Practice Management > Medical Policies > AZ Blue Plans-MCG Care Guidelines Search)
Prescription Drug Coverage
Content restricted by user role or network status (or both).2025 Code List
2024 Code List (Medicare Advantage tab)*
Inpatient Admissions Quick Guide
Part D FormularyPlans may have a different administrator for prior authorization (check the back of the member ID card):
Optum Health Network Arizona (OHNAZ)
Arizona Priority Care (AZPC)Fax Request
EviCore Request*
Optum Health Network Arizona (OHNAZ)
Arizona Priority Care (AZPC)
Quick Transfer Program - Acute Care to SNFPart D Drugs - Retail and Mail Order:
ePA covermymeds
ePA surescripts
Mail Order Fax 1-800-491-7997CMS National Coverage Determinations (NCD)
Local Coverage Determinations (LCD)
EviCore Guidelines
Medicare Advantage Ambulance ServicesMCG Care Guidelines (for anything not
covered by the above sources):
Call AZ Blue at 1-800-446-8331* All AZ Blue-administered Medicare Advantage plans are included in our eviCore Medicare Advantage program.- To access the CHS group’s utilization management information, call the number on the back of the ID card or use our search tool:
CHS Group - TPA Information Finder
Content restricted by user role or network status (or both). These plans use the following utilization management administrators:
Prefixes K8Y and K8Z:
AmeriBen at 1-800-388-3193
For pharmacy, Navitus at navitus.com or 1-866-333-2757Prefix MKQ:
AmeriBen at 1-866-879-6128
For pharmacy, Optum Direct at 1-800-207-2568Prefix NBT:
American Health Group at 1-800-847-7605
For pharmacy, Navitus at navitus.com or 1-855-673-6504Prefix PTP:
AmeriBen at 1-800-388-3193
For pharmacy, Prime Therapeutics (Prime) at primetherapeutics.com or 1-800-424-0472; Specialty Rx: 1-877-300-6202- Medicare Supplement plans (designed to cover payment gaps for those with traditional Medicare plans) align with CMS for coverage and medical necessity determinations. However, if a member’s Medicare Supplement plan covers benefits for foreign travel emergency services, AZ Blue will determine medical necessity.