Pre-Auth Check

Prior Authorization Changes – Temporary flexibility around post-acute requirements began Monday, 12/6/21. The changes are in effect through end of day Friday, 1/31/22. Details are outlined below

Ambetter (Marketplace) and Allwell (Medicare) Post-Acute Accommodations for rehab hospitals, Long Term Acute Care hospitals (LTACH) and SNF:
We will relax our requirements related to facility transfers including:

• We will not require discharging acute care facilities to obtain prior authorization for patient transfers to participating post-acute facilities. 
• We will not require sending facilities to provide notification of transfer to participating providers. 
• However, we will require receiving facilities to notify the health plan of patient admission.  And we will accept notification up to five days post-transfer.
• We will continue to conduct medical necessity review
• Because we will not have visibility prior to transfer, we request that hospitals utilize our in network post-acute facilities

Arizona Complete Health-Complete Care Plan (AzCH-CCP, Medicaid)
AzCH-CCP is following AHCCCS requirements outlined in the clinical delivery section of the AHCCCS COVID-19 FAQ page.  For criteria specific to Post-Acute services please refer to the most current AHCCCS Prior Authorization and Concurrent Review memo.

DME and O2:
Our partner, Preferred HomeCare (Phone: 800-636-2123),  will coordinate the delivery of DME and O2 prior to discharge upon notification from the discharging facility.

Home Health:
Our partner, Professional Health Care Network (PHCN) (Phone: (888) 705-5274), will coordinate the setup of home health prior to discharge upon notification from the discharging facility.