Prior Authorization Guidelines

What is Prior Authorization

Prior authorizations are a pre-service medical necessity review. A prior authorization is the process where we review the requested service or drug to see if it is medically necessary and covered under ACA StandardHealth with Health Choice. Not all services and drugs need prior authorization. A prior authorization is not a guarantee of benefits or payment. The terms of the member’s plan control the available benefits.

Prior Authorization Guidelines

Requests for services that require prior authorization can be submitted on the ACA StandardHealth with Health Choice form directly through the secure provider portal or via fax to the Authorizations department. All requests must include complete diagnosis and procedure codes, and the accompanying medical documentation (as needed).

In order to expedite prior authorization and provide quality services to our members, a contracted or preferred provider is recommended for all health care services for ACA StandardHealth with Health Choice members. Please note that all non-contracted providers must obtain prior authorization.

Submitting a Prior Authorization Request

• Through the Provider Portal
• ACA Standard Health with Health Choice PA FAX Line: 602-864-5308
• ACA StandardHealth with Health Choice Behavioral Health Out of Home Prior Auth Request FAX Line: 480-760-4732

Click here to access the PA Forms:

• Prior Authorization Forms

Checking PA Status:

You can view the status of Prior Auth requests on the Provider Portal.
If you have additional questions about Prior Auth requests please call 1-800-322-8670.

Dental Services Prior Authorization

Requests for dental services that require prior authorization can be submitted on our secure provider portal (Add the link to the provider portal) or by email using the dental prior authorization secured email: HCHDentalDeptHCA@azblue.com. Providers can also mail their requests to:

ACA StandardHealth with Health Choice
Attn: Dental Prior Authorizations
8220 N. 23rd Ave.
Phoenix, AZ 85021