Medicaid/RBHA Pre-Auth

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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 whether or not a prior authorization is needed, please submit a request for an accurate response.

Are Services being performed in the Emergency Department 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 services being rendered for pain management?
Are services, other than DME, orthotics, prosthetics, supplies, x-rays, home visits (DOMICILLARY) codes, therapeutic injections or labs being rendered in the home?
Are services being rendered in an unspecified location/place of service (other)?

Submit PA via FAX:

Provider Forms and Resources > Prior Authorization

Prior Auth Criteria

Care1st 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.