Prior Authorization Guidelines

At Health Choice Arizona, our goal is to work closely with you and your practice team to streamline and expedite prior authorization.

Many of the items on our abbreviated prior authorization list ask for notification only. Our centralized prior authorization center is designed to streamline processes resulting in timely expedited approval of prior authorization requests.

Prior Authorization Guidelines

Requests for services that require prior authorization can be submitted on the Health Choice Arizona Prior Authorization form by fax or requests can be phoned into the Health Choice Prior 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 Health Choice members. Please note that all non-contracted providers must obtain authorization for any service. All out of state provider must have or be willing to obtain a valid and current AHCCCS ID number. AHCCCS-covered out of state care must be of an urgent or emergent nature.

Health Choice Arizona Prior Authorization Grid
Medication Prior Authorization Criteria
NOTICE: Prior Authorization Grid Update

Submitting a Prior Authorization

To submit a new request, obtain information about a previously submitted request or to make an urgent request:

  • Heath Choice Arizona Medical PA Phone: 1-800-322-8670
  • Heath Choice Arizona Medical PA Fax Line: 1-877-422-8120
  • Health Choice Arizona Medical Referral Fax Line: 1-855-432-2494
  • Health Choice Arizona Pharmacy PA Fax Line: 877-422-8130

Click here to access Prior Authorization Forms.

You can also view the status of previously submitted requests on the Provider Portal.

Dental Services Prior Authorization

Health Choice Arizona requires all non-contracted dentists to obtain a Prior Authorization before rendering treatment. Please complete the Dental Specialty Referral Request Form and fax to 480-350-2217 or mail to:

Health Choice Arizona, Inc.
Attn: Dental Prior Authorization
410 N. 44th Street, Suite 520
Phoenix, AZ 85008

Dental Uniform Prior Authorization List


Health Choice Arizona is partnered with eviCore for radiology benefits management of select MR, CT, PET, ultrasound and cardiac imaging studies.

To submit a new request for imaging services and select cardiac testing/procedures, contact eviCore by:

Phone: 888-693-3211
Fax: 888-693-3210
Provider Portal: