Health Choice Arizona
 
Prior Authorization Requirements
All requests for services that require prior authorization must be submitted on the HCA Prior authorization form complete with diagnosis and procedure codes and with the accompanying medical documentation (as needed) or phoned into the Health Choice Arizona Prior Authorizations department.

A contracted or preferred provider is desired for all services for Health Choice members. All non-contracted services providers require authorization for any service. All out of state providers, to be considered, must have or be willing to obtain, a valid and current AHCCCS ID number (AHCCCS-covered out of state care must be of an urgent or emergent nature).

Please refer to the HCA Authorizations and Referrals Chapter 6 of the Provider Manual and the AHCCCS Medical Policy Manual for additional summary detail of covered and excluded services.

To check the status of a prior authorization request, use the website http://www.healthchoiceaz.com/generalproviders/ and sign into the Provider Portal.

To submit a new request, for information on a submitted request or for urgent requests, use the following HCA phone lines:

  • HCA Medical PA Department: 1-800-322-8670
  • Medical PA Fax Line: 1-800-323-9652 or 480-731-9557
  • Pharmacy PA Fax Line: 1-866-807-2049
The following list of medical, dental, DME, and pharmacy services is a thorough guideline but not necessarily a comprehensive listing of every service which may be rendered/covered under the AHCCCS program.

The service provider is ultimately responsible for verifying member AHCCCS eligibility and benefit coverage at the time services are rendered.

Prior Authorization Request Form - Medical ServiceNew
Prior Authorization Request Form - PharmacyNew
Dental Specialty Referral form

Effective for Dates of Service through 09/30/2010
Prior Authorization Guidelines - Full
    Prior Authorization Guidelines - Narrative only
    Prior Authorization Guidelines - Attachment A only
    Dental specific guidelines

Effective for Dates of Service beginning 10/1/2010
Prior Authorization Guidelines - FullNew
    Prior Authorization Guidelines - Narrative onlyNew
    Prior Authorization Guidelines - Attachment A onlyNew
    Prior Authorization Guidelines - Attachment B onlyNew

Orthotics and Prosthetics
Order through the following contracted service providers who will dispense and/or obtain necessary prior authorizations:

  • Advanced Prosthetics & Orthotics: 928-344-0030
  • Artisan Prosthetics: 1-877-755-9499
  • Fikes Orthotics, Brace and Limb: 480-981-7393
  • Fikes Orthopedic Specialists: 928-532-5822
  • Hamilton Prosthetic Center: 602-395-3354
  • Hanger Prosthetic and Orthotic: 1-877-442-6437
  • McCleve Orthotics and Prosthetics: 480-981-6767
  • Pongratz Orthotic and Prosthetics: 602-222-3032



AHCCCS Non-Covered Services - Effective untill 10/1/2010

  • Dental services for adults –All non-emergent service
  • Hearing Aids - For members who are 21 years of age and older
  • Prescriptive lenses - For members who are 21 years of age and older (except if medically necessary following cataract removal)
  • Personal care items – Unless needed to treat a medical condition
  • Exception: AHCCCS covers incontinence briefs for person over 3 and under 21 as described in AHCCCS Policy 430
  • Tubal Ligation/sterilization –Procedures for members under 21 years of age
  • Penile implants or vacuum devices - For AHCCCS members who are 21 years of age or older
  • AHCCCS does not cover experimental and/ or investigational services.
Any service that a requesting provider suspects may not be a covered service due to experimental/investigational status, should first seek PA approval.


Services with Special AHCCCS Considerations

  • Hysterectomy – AHCCCS Medical Policy Manual, Chapter 300
  • HIV/ AIDS treatment services - AHCCCS Medical Policy Manual, Chapter 300
  • Pregnancy Terminations - AHCCCS Medical Policy Manual, Chapter 400
  • Sterilization procedures - (all types) – AHCCCS Medical Policy Manual, Chapter 400