Overview

All prior authorization (PA) requests must be submitted by the service provider and include complete and accurate clinical documentation to support the medical necessity of the requested services.

• For Fee-for-Service (FFS) members, documentation requirements are outlined in Chapter 820 of the AHCCCS Medical Policy Manual (AMPM).
• All submissions must meet the clinical documentation quality standards described in Chapter 940 of the AMPM.
• Documentation must contain sufficient detail, as determined by DFSM PA reviewers, to justify the appropriateness of the requested services.

Important Notice: Requests submitted with incomplete, insufficient, or missing documentation may be pended or denied until all required information is received.

In cases of service denial, termination, suspension, or reduction, notice will be provided in accordance with 9 A.A.C. 34.

How to Submit a PA Request

The primary method for submitting PA requests is through the AHCCCS Online Provider Portal.

You can access the portal directly or find the link under the Plans/Providers menu on the AHCCCS website.

Follow these steps to ensure a smooth and complete PA submission process:

1. Create an AHCCCS Online Account

   New users must register for an account through the AHCCCS Online Portal.

2. Submit the Authorization Request

   Log in and enter your PA request using the PA submission link within the AHCCCS Online Portal.

3. Attach Required Documentation

   Upload all necessary clinical documentation identified in AHCCCS policy using the online attachment feature. Incomplete submissions may result in delays or denials.

4. Authorization Number Generated

   Once submitted, a case number is automatically assigned to your submission and the request is placed in pending status for review by the PA team.

5. Initial Confirmation Letter Sent

   A confirmation letter is mailed to the provider acknowledging receipt and the pending status of the PA request.

6. Determination Notification

   After your request has been reviewed, a second confirmation letter is mailed indicating the authorization decision.

7. Check Status Anytime

   Providers can monitor the status of submitted PA requests and view messages from PA staff via the Prior Authorization Inquiry link—available online 24/7.

Urgent Prior Authorization (PA) Requests

An urgent PA request, as defined in A.A.C. R9-34-306(B), applies when adhering to the standard processing timeframe could seriously jeopardize a Fee-for-Service (FFS) member’s life, health, or ability to attain, maintain, or regain maximum function.

Submission Steps for Urgent Requests

1. Submit the PA Request Online

   Enter the urgent PA request through the AHCCCS Online Provider Portal.

2. Provide Notification of Your Urgent Submission

   Immediately after submission, email the PA number to the Care Management (CM) team at Caremanagers@AZAHCCCS.gov to notify them of the urgent request.

3. Check Status

   Providers can verify the status of their urgent request within 24–72 hours of submission via the Provider Portal.

Important Notice: Urgent requests must include sufficient clinical detail to justify the urgency. Requests lacking this documentation will be processed under the standard PA timeframe.

Secondary PA Submission Method: Fax

While the AHCCCS Online Provider Portal remains the primary method for submitting prior authorization (PA) requests, fax submissions are permitted under limited circumstances for Fee-for-Service (FFS) providers:

When Fax Submission Is Allowed:

• Tribal ALTCS Acute Services

  The member is enrolled in the Tribal Arizona Long Term Care System (ALTCS) and the provider is requesting authorization for an acute service (e.g., inpatient hospital admission, surgery, behavioral health inpatient facility).

• Technical Outage

  The provider is unable to submit via the Provider Portal due to an internet or electrical outage. The nature of the outage must be clearly documented in the fax submission.

• Pending AHCCCS Online Credentials

  The provider has requested AHCCCS Online login credentials, and the service requiring authorization is scheduled to occur within four weeks of the credential request date.

Fax Submission Requirements:

All faxed PA requests must include the following as the cover page:

• A completed FFS PA Request Form (PA requests), or
• A completed FFS Medical Documentation form (supplemental non-service provider submissions)

Note: All required supporting clinical documentation must be attached behind the request form.

Faxed Authorization Status Verification:

• For urgent requests: Check status via the Provider Portal within 72 hours.
• For standard requests: Check status within ten calendar days.

Important Notice: Except for acute service requests for Tribal ALTCS members, fax submissions are a temporary accommodation. Providers are not permitted to use fax as a substitute for creating an AHCCCS Online Provider Portal or ID me account.

Requests that do not meet the criteria for faxed submission will not be processed and will be returned to the provider for resubmission via the AHCCCS Online Provider Portal.

FFS Fax Numbers

Request Type	Fax Number
Medical PA	602-256-6591
Utilization Review	602-254-2304
ALTCS	602-254-2426
Behavioral Health	602-253-6695
Non-Emergency Medical Transport	602-254-2431
Transplant	602-256-4860

Mailing Address (For Unique Circumstances Only)

AHCCCS-Division of Fee-for-Service Management
Care Management System Unit (CMSU), Mail Drop 8900
150 N. 18th Ave.
Phoenix, AZ 85007

Contact Information

General Contact Information:

• Provider Services: 602-417-7670 (Local) or
• Out-of-State Providers: 1-800-523-0231
  (Ask for the PA area or dial extension 602-417-4400)