Providers

Forms

BCBSAZ Health Choice Forms For Providers

Request for Participation

AzAHP Practitioner Practice – Change Form
Request for Participation – AzAHP Practitioner Data Form
AzAHP Organizational/Facility Application
Non Delegated Group AzAHP Roster

Prior Authorization Forms

Medical Services and Behavioral Health Prior Authorization Form
Residential Services PA Request Form 12.12.23 SLRFSDrf
Prior Authorization and Continued Stay Request Form for Psychiatric Inpatient and Sub-acute Facilities
BHIF, BHRF, TFC, and SUD BHRF Prior Authorization and Continued Stay Request Form

Other Forms

Care Management Referral Form
Fraud Waste & Abuse Referral Form
Newborn Reporting Form
Pediatric NICU Case Management Referral Form

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