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Pre-Auth Check Tool | Ambetter from Arizona Complete Health
Pre-Auth Check Tool
ATTENTION PROVIDERS: For authorization requests for date of service 1/1/18 and forward, utilize this tool to verify prior authorization requirements. To submit prior authorization by fax, please send to 866-597-7603.
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 that prior authorization is needed, please submit a request for an accurate response. All new, re-sequenced and unlisted codes (miscellaneous codes) require prior authorization, regardless of place of service.
Vision Services are handled by EyeMed.
Dental Services are handled by Envolve Dental.
High Tech Imaging services are handled by NIA.
Musculoskeletal services need to be verified by Turning Point
Chiropractic services are handled by ASH.
Oncology/supportive drugs for members age 18 and older need to be verified by New Century Health
Services provided by Out-of-Network providers are not covered by the plan. Join Our Network.
NOTE: Services related to an authorization denial will result in denail of all associated claims.
Are services being performed in the Emergency Department, or for Emergent Transportation?
|Types of Services||YES||NO|
|ARE SERVICES BEING PERFORMED OR ORDERED BY A NON-PARTICIPATING PROVIDER?|
|IS THE MEMBER BEING ADMITTED TO AN INPATIENT FACILITY?|
|ARE ANESTHESIA SERVICES BEING RENDERED FOR PAIN MANAGEMENT OR DENTAL SURGERIES?|
|IS THE MEMBER RECEIVING GENDER REASSIGMENT SERVICES?|
To submit a prior authorization Login Here.
For Home Health, please request prior authorizations through Professional Health Care Network (PHCN)
- Log into PHCN portal
- Call PHCN at 602-395-5100
- Fax to 480-359-3834