Prior 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
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