Prior Authorization & Clinical Guidelines

Last Updated: March 25, 2024 at 11:03 am

At BCBSAZ Health Choice Pathway HMO D-SNP, our goal is to work closely with providers to streamline and expedite prior authorization requests for our members. Many of the items on our abbreviated prior authorization list ask for notification only. Our centralized prior authorization center is designed to streamline processes resulting in timely expedited approval of prior authorization requests.

Prior Authorization Guidelines

Requests for services that require prior authorization can be submitted on the BCBSAZ Health Choice Pathway Prior Authorization form directly through the secure provider portal or via fax to the Authorizations department. All requests must include complete diagnosis and procedure codes, and the accompanying medical documentation (as needed).

In order to expedite prior authorization and provide quality services to our members, a contracted or preferred provider is recommended for all health care services for BCBSAZ Health Choice Pathway members. Please note that all non-contracted providers must obtain authorization for any service. All out of state provider 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.

Submitting a Prior Authorization

  • BCBSAZ Heath Choice Pathway Medical PA Phone: 1-800-656-8991
  • BCBSAZ Heath Choice Pathway Medical PA Fax Line: 1-877-424-5680
  • BCBSAZ Health Choice Pharmacy PA Fax Line: 1-877-424-5690
    Click here to access Prior Authorization Forms

Prior Authorization Forms

Medical Services Prior Authorization Form
Pharmacy Medication Prior Authorization Form
Medicare Part B Step Therapy Program


BCBSAZ Health Choice is partnered with EviCore for radiology benefits management of select MR, CT, PET, ultrasound and cardiac imaging studies.

To submit a new request for imaging services and select cardiac testing/procedures, providers may contact EviCore by:

Phone: 1-888-693-3211
Fax: 1-888-693-3210
Provider Portal:

Prior Authorization Guidelines

Prior Authorization Grid effective 1/5/24
Prior Authorization Grid Updates 11/15/23
(Updated - 11/15/2023 07:56 AM)

Prior Authorization Grid effective 8/10/2023
Prior Authorization Grid effective 5/1/2023
Prior Authorization Grid effective 2/1/2023
(Updated - 01/30/2023 10:57 PM)

Prior Authorization Grid effective 11/5/2022
Prior Authorization Grid effective 4/1/2022
Prior Authorization Grid effective 10/1/2021
Prior Authorization Grid effective 4/6/2021
(Updated - 03/29/2021 02:12 PM)

Prior Authorization Guidelines effective 1/1/2021

Clinical Guidelines and Recommendations

Centers for Medicare and Medicaid Services – Medicare Coverage Database

BCBSAZ Health Choice Pathway utilizes:

  • InterQual
  • UpToDate
  • National Coverage Determinations (NCD) 
  • Local Coverage Determinations (LCD)

Adult Hypertension Management Guidelines (NHLBI)

JNC 7 Report on Prevention, Detection, Evaluation and Treatment of High Blood Pressure

Adult Obesity Management Guidelines (NHLBI and NIDDKD)

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults

Asthma & COPD Management Guidelines (NHLBI)

Guidelines for the Diagnosis and Management of Asthma
COPD Guidelines

Cardiac and CVA Care Management (ACC/AACE)

NCEP III Guideline

HIV Management Guidelines


Smoking Cessation Guidelines (NIH)

Tobacco Cessation

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