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AHCCCS Home > Plans, Providers, Contractors & Vendors Home > FFS Claiming Services > This Page

AHCCCS Prior Authorization Forms

The Prior Authorization (PA) unit at AHCCCS authorizes specific services prior to delivery of medical related services.

PA request status can be viewed online.

Forms used in PA Unit include the following:

  • FESP Initial Dialysis Case Creation Form
  • FESP Monthly Certification of Emergency Medical Condition
  • Durable Medical Equipment (DME) Authorization Request Form
  • Home Health Prior Authorization Request
  • Prior Approval/Authorization Request - Form C
  • Rx America Prior Authorization Request Form
  • Therapy Authorization Request Form
  • American Indian Health Program (AIHP)/FFS Prior Authorization Request Form
 
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