Behavioral Health

• BH Initial Request for Treat. Auth Form
• BH Follow Up Request for Treat. Auth Form

Provider Forms and Help Sheets

• Provider Network & Contracting Department Help Sheets
  • Provider Network & Contracting Information for Provider/Group Updates

• Providers or Groups Requesting to Contract with AZPC
  • New Practice Group Participation Request Form
• Forms for Existing Groups Contracted with AZPC
  • Existing Practice Group Participation Request Form
  • Physician Assistant Delegation of Services Agreement
  • Provider/Physician Roster – Fillable PDF
  • Provider/Physician Roster – Spreadsheet Version
  • Ancillary Facility Application
  • Provider/Group Update Form
  • Demographic Update Form
  • Individual Provider Termination Form
  • Group Termination Request Form
• Compliance Forms
  • PQI Notification Form

Other

• Provider Manual