Please rate Care 1st Arizona Prior Authorization Form Rev. 06-23-2022
Standard requests: determination within 14 calendar days of receiving all necessary information.
Urgent requests: certify this request is urgent and medically necessary to treat an injury, illness or condition within 72 hours.
Clinical information: copies of all supporting clinical information are required.
Eligibility: member must be eligible at the time services are rendered.
Fax to: Physical Health 833-618-1979, Behavioral Health Requests 833-592-1301, Biopharmacy 833-417-0447.
| Question | Answer |
|---|---|
| Form Name | AN-PAF-6309 |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 35 |
| Avg. time to fill out | 6 min |
| Edition | Rev 06 23 2022 |
| Other names | AN-PAF-6309, PAF-6309, Medicaid Outpatient Authorization, Arizona Care1st Medicaid Outpatient Authorization |
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Please rate Care 1st Arizona Prior Authorization Form Rev. 06-23-2022
