All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. For specific details, please refer to the provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response. All new, re-sequenced and unlisted codes (miscellaneous codes) require prior authorization, regardless of place of service.
For Home Health, please request through Professional Health Care Network (PHCN)
Preventative Vision Services need to be verified by Envolve Vision.
Dental Services need to be verified by Envolve Dental.
Complex imaging, MRA, MRI, PET, and CT scans need to be verified by NIA.
Musculoskeletal Services need to be verified by Turning Point
Chiropractic services are handled by American Specialty Health Network (ASH).
Transportation services are handled by Medical Transportation Brokerage of Arizona (MTBA).
Requests for elective clinical trials must be submitted as
expedited requests and with the completed
MEDICAID ATTESTATION FORM ON THE APPROPRIATENESS
OF THE QUALIFIED CLINICAL TRIAL
found in the AHCCC Medical Policy Manual Section 320B.
Non-participating providers must submit Prior Authorization for all services except those performed in the Emergency Department and Urgent Care.
For non-participating providers, Join Our Network.
Are Services being performed in the Emergency Department or Urgent Care Center or Family Planning services billed with a Contraceptive Management diagnosis?
|Types of Services||YES||NO|
|Is the member being admitted to an inpatient facility?|
|Are anesthesia services being rendered for dental procedures?|
|Are services, other than DME, orthotics, prosthetics, supplies, X-rays, home visits (Domiciliary) codes, home infusion or labs being rendered in the home?|
|Are services being rendered in an unspecified location/place of service (other)?|
Prior Authorization (PA) Changes
Arizona Complete Health-Complete Care Plan utilizees Prior Authorization criteria that has been reviewed and approved by AHCCCS. To review prior aurhorization requirements for a drug that requires PA or is not on the Care1st formulary visit the AHCCCS Pharmacy page.
Additional PA criteria may apply. For drug specific PA Criteria not inclided on the AHCCCS Fee-For-Service PDF (link above), please call provider services at 866-560-4042 to request a copy of the PA criteria.
For oncology/supportive drugs, please request through New Century Health.
- Log into New Century Health’s provider web portal at https://my.newcenturyhealth.com.
- Submit an eFax to New Century Health at 1-213-596-3783 or send email to eFax email address at email@example.com
- Contact New Century Health’s Utilization Management Intake Department at 1-888-999-7713, Option 2 (Monday through Friday, 5 a.m. – 5 p.m. PST)
Please note, failure to obtain authorization may result in administrative claim denials.
For Home Health, please request prior authorizations through Tango Care (formerly PHCN)