Medicare Prior Authorization Updates

Date: 02/12/24

List effective 10/1/2023

Effective October 1, 2023, changes were made to Medicare prior authorization requirements. Pages 2-7 of this communication  outline the specifics. While many of the codes already reflected  these PA rules when viewed in our Medicare Pre-Auth Check Tool, we  apologize for our delay in sending this notification.

Please verify eligibility and benefits prior to rendering services for members. Even if a code does not require prior authorization, it is critical to confirm the service is covered. Payment, regardless of authorization, is contingent upon the member’s eligibility at the  time service is rendered and the service being covered. NON-PAR  PROVIDERS & FACILITIES REQUIRE AUTHORIZATION FOR ALL  SERVICES EXCEPT WHERE INDICATED.

For confirmation of prior auth requirements and code coverage for
all codes, please use the Pre-Auth Check Tool on our website at: https://www.azcompletehealth.com For Providers >
Pre-Auth Check.

AzCH providers and staff:
If you have questions, please contact your AzCH Provider  Engagement Specialist. If you need your assigned Provider  Engagement Specialist’s contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.

Care1st providers and staff:

If you have questions, please call Network Management at 1-866-560-4042 (Options in order: 5, 7) or email SM_AZ_PNO@care1staz.com.