Medicaid/RBHA Pre-Auth
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.
Oncology and Supportive Drugs needs to be verified by New Century Health
Complex imaging, MRA, MRI, PET, and CT scans need to be verified by NIA
Dental Services need to be verified by Envolve Dental
For Home Health, please request through Professional Cares
Musculoskeletal Services need to be verified by Turning Point
Transportation services are handled by Medical Transportation Brokerage of Arizona (MTBA)
Non-participating providers must submit Prior Authorization for all services except those performed in the Emergency Department.
For non-participating providers, Join Our Network.
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)? |
To submit a prior authorization Login Here.
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.