Arizona Complete Health Prior Authorization Lookup
Latest Arizona Complete Health prior authorization updates19
- Prior AuthClinical/Medical PolicyEff. 2026-02-01Durable Medical Equipment (DME) and Orthotics & Prosthetics Coverage CriteriaClinical coverage criteria for medical necessity, coding, and review requirements for a broad range of DME, orthotics and prosthetics items provided by Arizona Complete Health / Centene-affiliated health plans. This brief covers the portion of the policy text provided (part 1 of 2) and is intended for billing and clinical operations staff to determine coverage rules, prior authorization and coding implications.All Arizona Complete Health updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-01Medicare Outpatient Authorization — ArizonaGoverns prior authorization requests for Medicare outpatient services for Arizona Complete Health Medicare members in Arizona, specifying submission channels, timelines, and required information for providers and facilities.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyEff. 2025-12-31AZ Complete Health CMS Final Rule 0057-F Prior Authorization Requirements: 102 (PDF)This part lists procedure and service groupings with associated CPT/HCPCS/T-Codes that may require prior authorization under Arizona Complete Health. It notes the ordering/prescribing provider is responsible for determining which specific codes require prior authorization.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyEff. 2025-12-31Wellcare CMS Final Rule 0057-F Prior Authorization Requirements: H0351 & H5590 (PDF)This part lists procedure and service codes that require prior authorization as of 12/31/2025 for Arizona Complete Health (Wellcare CMS Final Rule 0057-F). It enumerates codes across multiple service categories (spinal surgeries, PT/OT/Speech therapy, plastic surgery, respiratory, audiology, injections/infusions, transportation, urology/kidney) and indicates the effective date for PA requirement.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyEff. 2025-09-01Clinical Policy: Clinical TrialsDefines medical necessity and coverage for routine costs and management of complications for members/enrollees participating in qualifying clinical trials for Arizona Complete Health (Centene-affiliated plans). Applies to providers submitting claims or prior authorizations for trial-related routine care.All Arizona Complete Health updates
- Prior AuthReimbursement/Payment PolicyEff. 2025-04-01Acute - Long Term Care Drug List (behavioral health and stimulants)Drug coverage preferences, prior authorization requirements, quantity limits, and preferred status for multiple drug classes (including ADHD/stimulants, opioid use disorder treatments, and behavioral health agents) for Arizona Complete Health members; applies to pharmacy benefit and prescribers/pharmacies serving members.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyEff. 2024-07-16Concomitant Antipsychotic TreatmentPolicy governing prior authorization and medical necessity criteria for concomitant use of two second-generation (atypical) antipsychotics for Arizona Complete Health members (Arizona Medicaid/AzCH-CCP). Applies to prescribers and behavioral health providers managing antipsychotic therapy.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyEff. 2024-02-01Multiple Sclerosis Drugs (Lemtrada, mitoxantrone)Defines prior authorization, coverage criteria, dosing limits, and continuation requirements for alemtuzumab (Lemtrada) and mitoxantrone for Arizona Complete Health (Arizona Medicaid) members.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyEff. 2023-07-16Concomitant Antidepressant TreatmentPolicy governing medical necessity and prior authorization criteria for concomitant use of more than one antidepressant for members of Arizona Complete Health - Arizona Medicaid (AzCH-CCP). Applies to providers seeking approval for combinations such as two SSRIs, an SSRI with an SNRI, or two SNRIs.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyEff. 2020-04-15Herceptin/Biosimilars, Trastuzumab-Hyaluronidase (coverage criteria)Defines medical necessity and prior authorization criteria for trastuzumab, its biosimilars, and trastuzumab-hyaluronidase (Herceptin Hylecta) for Arizona Complete Health Medicaid lines of business (AzCH-CCP and Care1st). Applies to providers prescribing these agents for oncology indications.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-20Rifapentine (Priftin) coverage and PA criteriaDefines medical necessity, prior authorization, dosing, and coverage criteria for rifapentine (Priftin) for treatment of active pulmonary tuberculosis and latent tuberculosis infection for Arizona Complete Health members.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyEff. 2016-11-16Proton Pump Inhibitors (PPIs) prior authorizationDefines medical necessity and prior authorization requirements for specific proton pump inhibitor products for Arizona Complete Health (AzCH-CCP) members, including initial and continuation criteria, dose limits, and documentation expectations.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyEff. 2011-12-01Bevacizumab (Alymsys, Avastin, Avzivi, Jobevne, Mvasi, Vegzelma, Zirabev)Defines medical necessity, prior authorization, step therapy, and coverage criteria for bevacizumab and listed biosimilars across oncology and selected off-label ophthalmology and pediatric uses for Arizona Complete Health lines of business.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyEff. 2009-10-01Smoking Cessation Pharmacotherapy CoverageDefines Arizona Complete Health (AHCCCS) coverage, prior authorization, and limits for nicotine replacement therapies and prescription smoking cessation medications for eligible members.All Arizona Complete Health updates
- Prior AuthAdministrative/Operational PolicyArizona Standardized Prior Authorization Request for Medication, DME, and Medical DeviceThis document provides the Arizona Complete Health standardized prior authorization submission form and instructions for medications (pharmacy and provider-administered), durable medical equipment (DME), prosthetics/orthotics, and medical devices for use by providers submitting authorization requests.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyMedicare Inpatient Authorization — ArizonaForms and procedures for requesting prior authorization for Medicare inpatient admissions for Arizona Complete Health members, including expedited and concurrent request pathways and required information providers must submit.All Arizona Complete Health updates
- Prior AuthAdministrative/Operational PolicyPrior Authorization / Formulary Exception Request Fax FormThis document describes Arizona Complete Health's faxable prior authorization and formulary exception request form and instructions for submitting requests (including use of CoverMyMeds) for providers and pharmacies serving AzCH members.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyRespiratory Syncytial Virus (RSV) - Synagis (palivizumab) prior authorizationThis document is a prior authorization/prescription form governing requests for Synagis (palivizumab) for prevention of severe RSV in pediatric patients; it affects prescribing providers, specialty pharmacies, and prior authorization reviewers for Arizona Complete Health members.All Arizona Complete Health updates
- Prior AuthClinical/Medical PolicyTransplant Service Documentation RequirementsDefines required clinical documentation and testing for transplant evaluation, listing, and post-transplant follow-up for solid organ and stem cell/bone marrow transplants; applies to providers submitting prior authorization requests to the health plan.All Arizona Complete Health updates
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Tool Description
Search Arizona Complete Healthprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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