Providers

Provider Manual

Last Updated: April 18, 2023 at 9:42 am

The provider manual provides important information about BCBSAZ Health Choice Pathway.

 

Chapter 1

Introduction to BCBSAZ Health Choice Pathway (Updated - 04/19/2023 06:01 PM)
Exhibit 1-1 Provider Escalation Notice (Updated - 04/19/2023 06:00 PM)
Chapter 2

Member Services (Updated - 04/19/2023 05:43 PM)
Exhibit 2.1 Member Dual ID Card (Updated - 04/19/2023 05:32 PM)
Exhibit 2.2 Medicare ID Card (Updated - 04/19/2023 05:32 PM)
Chapter 3

Provider Responsibility (Updated - 04/27/2023 11:09 PM)
Chapter 4

Cultural Competency (Updated - 04/19/2023 05:43 PM)
Chapter 5

Quality Management (Updated - 04/19/2023 05:36 PM)
Chapter 6

Medical Authorizations and Notifications (Updated - 06/06/2022 05:14 AM)
Exhibit 3-6.12 Maternal Risk Assessment Form
Exhibit 5-1 Care Management Referral Form (Updated - 04/19/2023 05:45 PM)
Prior Authorization Guidelines effective 5/1/2023 (Updated - 05/03/2023 07:32 PM)
Prior Authorization Guidelines effective 2/1/2023 (Updated - 01/30/2023 10:57 PM)
Prior Authorization Guidelines effective 11/5/2022 (Updated - 11/01/2022 10:54 PM)
Prior Authorization Guidelines effective 4/1/2022
Prior Authorization Guidelines effective 10/1/2021 (Updated - 09/14/2021 04:51 PM)
Exhibit 6-2 Medical Services Prior Authorization Form
Exhibit 17-1 Pharmacy Medication Prior Authorization Form
Chapter 7

Inpatient & Outpatient Hospital Care
Chapter 8

Coordination of Benefits or Other Insurance Liability (Updated - 04/19/2023 06:01 PM)
Chapter 9

Grievance, Appeals, Claim Resubmission and Reconsiderations (Updated - 04/19/2023 06:01 PM)
Chapter 10

Drug Formulary (Updated - 02/14/2023 08:40 AM)
Exhibit 17-1 Pharmacy Medication Prior Authorization Form
Chapter 11

Transplant Services (Updated - 04/19/2023 05:44 PM)
Chapter 12

Covered Benefits (Updated - 05/25/2023 06:02 PM)
Exhibit 12-1 Supplemental Benefit Comparison Chart
Exhibit 12-2 2023 CPT Codes for Supplemental Benefits  (Updated - 04/19/2023 10:08 AM)
Chapter 13

Care Management (Updated - 04/25/2022 11:35 AM)

 

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