Blue Cross and Blue Shield of Arizona Prior Authorization Form: A Step-by-Step Guide

‍Introduction

The Blue Cross and Blue Shield of Arizona (BCBSAZ) prior authorization process is essential for ensuring that specific medical procedures, treatments, and prescriptions are covered under a patient’s health plan. Prior authorization helps prevent unnecessary treatments and ensures that healthcare services align with medical necessity guidelines.

This guide will walk you through the step-by-step process of completing and submitting the BCBSAZ prior authorization form to prevent delays and denials.

What is Prior Authorization?

Prior authorization (PA) is a requirement by Blue Cross and Blue Shield of Arizona that mandates healthcare providers to obtain approval before administering certain medications, medical procedures, or services. This ensures that treatments meet medical necessity standards and are covered under the patient’s health plan.

When is Prior Authorization Required?

BCBSAZ requires prior authorization for various medical services, including but not limited to:

• Advanced diagnostic imaging (MRI, CT scans, PET scans)
  
  
• Specialty medications (biologics, infusion therapy)
  
  
• Durable medical equipment (DME)
  
  
• Physical therapy and rehabilitation services
  
  
• Elective and complex surgical procedures
  
  
• Behavioral health services
  
  
• Home healthcare services

Failing to secure prior authorization can lead to claim denials and out-of-pocket costs for patients.

Step-by-Step Guide to Completing the BCBSAZ Prior Authorization Form

Step 1: Download the Prior Authorization Form

Where to get it

Step 2: Provide Patient Information

Accurate patient details are essential for ensuring approval. Fill in the following details:

• Full Name
  
  
• Date of Birth
  
  
• Member ID Number
  
  
• Patient’s Contact Information
  
  

Incorrect patient information may lead to delays in processing the request.

Step 3: Enter Provider Details

The requesting healthcare provider must include:

• Provider’s Full Name and NPI Number
  
  
• Practice or Hospital Name
  
  
• Provider’s Specialty
  
  
• Phone, Fax, and Email
  
  

BCBSAZ may contact the provider for additional documentation or clarifications.

Step 4: Specify the Requested Service

Mention the medical service, medication, or procedure requiring authorization. Include:

• CPT or HCPCS Codes (for procedures)
  
  
• ICD-10 Diagnosis Codes
  
  
• Service Start and End Dates
  
  
• Frequency and Duration (if applicable)
  
  

Providing precise codes ensures faster processing and fewer denials due to missing details.

Step 5: Justify Medical Necessity

Submit supporting clinical documentation that justifies why the service is necessary. Include:

• Patient’s Medical History & Progress Notes
  
  
• Relevant Lab Reports or Imaging Results
  
  
• Treatment Plan & Expected Outcomes
  
  
• Alternative Treatments Tried (if applicable)
  
  

A strong medical necessity justification improves approval chances.

Step 6: Submit the Form

Once the prior authorization form is complete, submit it via one of the following methods:

1. Online Submission:

• Use the BCBSAZ provider portal for faster processing.
  
  

2. Fax Submission:

• Send the completed form to the BCBSAZ fax number listed on the form.
  
  

3. Phone Submission:

• Call the BCBSAZ provider support line for urgent prior authorization requests.

Step 7: Track Your Prior Authorization Request

After submission, you can track the previous authorization status through:

• BCBSAZ Provider Portal
  
  
• Phone Follow-ups with BCBS Arizona Customer Service
  
  
• Email or Fax Notifications
  
  

Keeping track ensures you can quickly respond to additional information requests from BCBSAZ.

Common Reasons for Prior Authorization Denials

To avoid delays or denials, ensure:

• Incomplete or incorrect forms are corrected before submission.
  
  
• Medical necessity documentation is comprehensive.
  
  
• The procedure or medication aligns with BCBSAZ’s coverage policies.
  
  
• The request is submitted before the service date.

How Long Does Prior Authorization Take?

Processing times for BCBSAZ prior authorization requests vary based on urgency and service type:

• Standard Requests: Typically processed within 5-7 business days.
  
  
• Urgent Requests: Expedited within 24-48 hours.
  
  

Providers should submit requests well in advance to avoid delays in patient care.

Conclusion

Submitting a Blue Cross and Blue Shield of Arizona prior authorization form correctly is crucial for avoiding claim denials and ensuring timely patient care. By following the step-by-step guide, including accurate details, using the BCBSAZ provider portal, and tracking requests, healthcare providers can streamline the approval process.

For further details, visit the BCBSAZ Prior Authorization page or contact BCBSAZ provider support.