You are invited to participate in a survey regarding your experience using the AHCCCS
website. This survey will take approximately two minutes. Your responses will help
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The Medical Documentation Form The Medical Documentation Form is to be utilized when submitting additional documentation that has not been previously submitted and is needed to substantiate medical necessity and appropriateness of services requested. This form should also be used when submitting additional documentation for concurrent review or when a Prior Authorization has been pended requesting additional documentation.
Medical Documentation Form
You may phone or fax the AHCCCS Prior Authorization Unit to request authorization.
To obtain a prior authorization by telephone, providers must call Monday
through Friday between 9am to 11:30am, and 12:30pm to 4pm.
The AHCCCS Prior Authorization Unit's fax number is 602-256-6591.
Allow at least three working days for your request to be processed.
Adobe Acrobat Reader is required to view PDF files. This is a free program available
from the Adobe web site. Follow the download directions on the Adobe
web site to get your copy of Adobe Acrobat Reader.