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Revision to an Existing PA When Procedure Is Modified

Date: 05/02/25

REVISION TO AN EXISTING PRIOR AUTHORIZATION WHEN THE PROCEDURE IS MODIFIED

We understand there are occasions when clinical decisions are made during a procedure that can result in a similar yet different service(s) being rendered to a member than the service(s) approved through the prior authorization process.  

To improve claim processing and prevent a claim denial due to a mismatch between the prior authorization and the claim, please take the following steps:Request an update to the prior authorization when the rendered service(s) differs from the originally approved service(s) within 30 calendar days of the service date

  1. In your request reference the existing prior authorization number, clearly indicate the change in service provided, explain the reason for the change, and include relevant notes or documentation
  2. Submit the request electronically (preferred) via the prior authorization option available in our secure provider portal or Availity, or via fax (fax number(s) are noted on the applicable prior authorization form). The request will trigger the Utilization Management team to review and update the prior authorization
  3. Obtain confirmation of the updated prior authorization prior to submitting the claim

References

  1. AZ Complete Health portal log on page: https://www.azcompletehealth.com/providers/login.html
  2. Availity log on page: https://apps.availity.com/web/onboarding/availity-fr-ui/#/login
  3. Prior authorization forms are located on our website www.azcompletehealth.com > For Providers > Pre-Auth Check

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