Utilization Management

Authorization is required for hospital admissions and certain specialty services, including outpatient services.

Prior Authorization is obtained by means of a completed Prior Authorization Form.

Failure to secure a prior authorization before rendering services may result in denial of claims payment.

Affirmative Statement About Incentives:

• Utilization Management (UM) decision making is based only on appropriateness of care and service existence of coverage
• The organization does not specifically reward practitioners or other individuals for issuing denials of coverage or service care
• Financial incentives for UM decision makers do not encourage decisions that result in under-utilization

UM Criteria

Treating providers may request a copy of the criteria used in making UM decisions by calling (480) 499-8700 or submitting a request in writing to:

AZPC Prior Authorization Department, 585 N. Juniper Dr., Ste 200, Chandler, AZ 85226

Prior Authorization Resources

• Prior Authorization Request Form
•  Part B Drug Prior-Authorization Request Form
•  Medicare Part B vs Part D-CMS2015
•  Services that Do Not Require Auth
•  Diabetic Testing Supply Order Form
•  AZPC Plan Redirect Form
• UM Program
• 2022 Behavioral Health UM Program