Providers

Provider Manual

Last Updated: November 22, 2023 at 10:26 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 - 10/12/2023 02:26 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 - 08/02/2023 04:42 PM)
Chapter 4

Cultural Competency
(Updated - 11/09/2023 03:14 PM)
Chapter 5

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

Medical Authorizations and Notifications
(Updated - 11/09/2023 03:18 PM)
Exhibit 3-6.12 Maternal Risk Assessment Form
Exhibit 5-1 Care Management Referral Form
(Updated - 04/19/2023 05:45 PM)
Prior Authorization Grid effective 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
Exhibit 6-2 Medical Services and Behavioral 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 - 08/02/2023 04:42 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
(Updated - 07/07/2023 10:37 AM)
Exhibit 12-2 2023 CPT Codes for Supplemental Benefits 
(Updated - 04/19/2023 10:08 AM)
Chapter 13

Care Management
(Updated - 11/09/2023 01:29 PM)

 

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